title: Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT±concurrent chemotherapy.
abstract: There is limited prospective data reporting the extent of treatment related toxicities associated with helical Intensity Modulated Radiotherapy (H-IMRT) for head and neck cancer (HNC). The study aim was to investigate severity, peak incidence and recovery patterns of dysphagia and related toxicities in patients undergoing H-IMRT±chemotherapy to examine when patients are experiencing symptoms requiring supportive clinical care.
  
  
  
  Prospective study of 212 patients undergoing H-IMRT. Dysphagia and associated acute toxicities were monitored weekly during treatment and at weeks 2, 4 and 12 post treatment using the CTCAE v4, Functional Oral Intake Score and National Dysphagia Diet Descriptors.
  
  
  
  75% experienced Grade 2-3 dysphagia. Over 70% had grade 2-3 dysguesia, xerostomia, and thick saliva, and >50% experienced grade 2-3 pharyngeal mucositis, oral mucositis, and nausea. 13% patients declined to NBM requiring complete enteral nutrition, 25% required enteral nutrition but maintained some form of oral intake. Symptoms peaked in final week of treatment, consistently improving thereafter, with the majority better than baseline by 12 weeks post-treatment. Concurrent chemotherapy at least doubles the odds of experiencing most symptoms excepting xerostomia, taste and fluid level.
  
  
  
  Despite advancements in radiation techniques, results confirm a high proportion of HNC patients experience dysphagia and related toxicities requiring supportive care during H-IMRT. Patients receiving H-IMRT alone experience a lower incidence of symptoms compared with those receiving concurrent chemotherapy. The data confirms the ongoing need for active on treatment monitoring with implications for the timing and intensity of patient support services.
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia; The University of Queensland, School of Health & Rehabilitation Sciences, Australia.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Moroney
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Helios
authors.affiliation: The University of Queensland, School of Health & Rehabilitation Sciences, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health Service, Australia.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Crombie
authors.affiliation: QIMR Berghofer Medical Research Institute, Australia.
authors.forename: Leesa F
authors.initials: LF
authors.lastname: Wockner
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia; The University of Queensland, School of Health & Rehabilitation Sciences, Australia.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Burns
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia.
authors.forename: Ann-Louise
authors.initials: AL
authors.lastname: Spurgin
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Blake
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia; School of Medicine, The University of Queensland, Australia.
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Kenny
authors.affiliation: Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, Australia; School of Medicine, The University of Queensland, Australia.
authors.forename: Brett G M
authors.initials: BG
authors.lastname: Hughes
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D059248:Chemoradiotherapy; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents
keywords: Chemoradiotherapy; Dysphagia; Head and neck cancer; Helical tomotherapy; IMRT; Intensity modulated radiotherapy; Swallowing; Toxicity