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A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy

A systematic review by the Italian Head and Neck Radiotherapy Study Group

Ein Vergleich von Schluckstörungen nach dreidimensionaler konformaler und intensitätsmodulierter Strahlentherapie

Ein systematischer Review der “Italian Head and Neck Radiotherapy Study Group”

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

Dysphagia is one of the most important treatment-related side effects in head and neck cancer (HNC), as it can lead to severe life-threating complications such as aspiration pneumonia and malnutrition. Intensity-modulated radiotherapy (IMRT) could reduce swallowing dysfunction by producing a concave dose distribution and reducing doses to the swallowing-related organs at risk (SWOARs). The aim of this study was to review the current literature in order to compare swallowing outcomes between IMRT and three-dimensional conformal radiotherapy (3DCRT).

Methods

A search was conducted in the PubMed and Embase databases to identify studies on swallowing outcomes, both clinically and/or instrumentally assessed, after 3DCRT and IMRT. Dysphagia-specific quality of life and objective instrumental data are summarized and discussed.

Results

A total of 262 papers were retrieved from the searched databases. An additional 23 papers were retrieved by hand-searching the reference lists. Ultimately, 22 papers were identified which discussed swallowing outcomes after 3DCRT and IMRT for HNC. No outcomes from randomized trials were identified.

Conclusion

Despite several methodological limitations, reports from the current literature seem to suggest better swallowing outcomes with IMRT compared to 3DCRT. Further improvements are likely to result from the increased use of IMRT plans optimized for SWOAR sparing.

Zusammenfassung

Hintergrund

Dysphagie ist eine der wichtigsten Nebenwirkungen bei der Behandlung von Kopf-Hals-Tumoren (HNC), da sie zu lebensbedrohlichen Komplikationen wie Aspirationspneumonien und Mangelernährung führen kann. Durch Erzeugung konkaver Dosisverteilungen und durch die Reduzierung der Dosis an schluckrelevanten Strukturen (SWOAR) kann die IMRT Schluckstörungen möglicherweise vermindern. Ziel dieser Studie war es, die gegenwärtige Literaturlage hinsichtlich der Schluckfunktion nach IMRT und konformaler dreidimensionaler Strahlentherapie (3DCRT) systematisch zu überprüfen.

Material und Methoden

Studien, die die Schluckfunktion nach 3DCRT und IMRT klinisch und/oder instrumentell untersuchten, wurden durch eine Datenbankrecherche in PubMed und Embase identifiziert. Schluckbezogene Lebensqualität und objektiv instrumentell erhobene Daten wurden zusammengefasst und diskutiert.

Ergebnisse

Insgesamt wurden 262 Manuskripte aus den Datenbanken extrahiert. Weitere 23 Manuskripte wurden durch manuelle Suche in den Literaturlisten ermittelt. Schließlich wurden 22 Arbeiten identifiziert, welche die Schluckfunktion nach 3DCRT und IMRT zum Gegenstand hatten. Darunter waren keine randomisierten Studien.

Schlussfolgerung

Trotz methodisch bedingter Einschränkungen der Aussagekraft dieser Analyse legt die gegenwärtige Literaturlage bessere Ergebnisse hinsichtlich der Schluckfunktion nach IMRT im Vergleich zu 3DCRT nahe. Weitere Verbesserungen werden wahrscheinlich durch die gezielte Optimierung von IMRT-Plänen hinsichtlich der SWOAR resultieren.

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Authors and Affiliations

  1. Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56126, Pisa, Italy

    Stefano Ursino MD, Riccardo Morganti, Agostino Cristaudo & Fabiola Paiar

  2. Radiation Oncology, University Hospital, Largo del Pozzo 74, 44125, Modena, Italy

    Elisa D’Angelo & Frank Lohr

  3. Radiation Oncology, Sacro Cuore-Don Calabria Cancer Care Center, Via Don Sempreboni 5, 37024, Negrar-Verona, Italy

    Rosario Mazzola

  4. Radiation Oncology, S.Croce e Carle Hospital, Via M. Coppino 26, 12100, Cuneo, Italy

    Anna Merlotti & Elvio Grazioso Russi

  5. Radiation Oncology, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Roma, Italy

    Daniela Musio

  6. Radiation Oncology, Advanced Radiotherapy Center, European Institute of Oncology, Via G. Ripamonti 435, 20141, Milan, Italy

    Daniela Alterio

  7. Radiation Oncology, AOU IRCCS San Martino – IST National Cancer Research Institute and University, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Almalina Bacigalupo

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  1. Stefano Ursino MD
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  2. Elisa D’Angelo
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Correspondence to Stefano Ursino MD.

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Conflict of interest

S. Ursino, E. D’Angelo, R. Mazzola, A. Merlotti, R. Morganti, A. Cristaudo, F. Paiar, D. Musio, D. Alterio, A. Bacigalupo, and E.G. FRussiand. Lohr declare that they have no competing interests.

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Ursino, S., D’Angelo, E., Mazzola, R. et al. A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy. Strahlenther Onkol 193, 877–889 (2017). https://doi.org/10.1007/s00066-017-1160-7

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