Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer
Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer
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DOI：
10.1007/s00455-012-9394-0
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发表时间：
2012-12-01
期刊：
影响因子：
2.6
通讯作者：
Porceddu, Sandro
中科院分区：
文献类型：
--
作者：
Cartmill, Bena;Cornwell, Petrea;Porceddu, Sandro
由于迄今为止在已发表的研究中没有长期数据，本研究提供了吞咽结果的详细信息，以及在改变分割放疗伴随加强（AFRT-CB）后2年口服摄入和体重维持的障碍和促进因素。12名接受AFRT-CB的T1-T3口咽癌患者在基线、治疗后6个月和2年评估了吞咽困难和唾液毒性、食物和液体耐受性、功能性吞咽结果、患者报告的功能和体重。在2岁时，参与者还接受了采访，以探讨口服摄入的障碍和促进因素。与基线相比，2年时晚期毒性、功能性吞咽和患者评定的吞咽物理方面的结局显著更差。大多数患者（83%）耐受全饮食预处理，但在2年时该比率降至42%（其余患者耐受软饮食）。确定了影响活动和参与水平的多种口服摄入障碍。参与者从基线到2年减轻了11公斤，在6个月到2年之间没有恢复。全球，社会和情感领域的患者报告的功能恢复到治疗前的水平。在AFRT-CB后2年，唾液和吞咽困难毒性恶化，功能性吞咽下降，以及多个报告的持续口服摄入障碍对参与者的活动和与进食相关的参与水平产生了负面影响。这些持续的缺陷导致MDADI确定的身体吞咽功能显著恶化。相比之下，患者在2年时感觉到他们的更广泛功能有所改善，这表明需要对持续的吞咽缺陷进行长期调整。
With no long-term data available in published research to date, this study presents details of the swallowing outcomes as well as barriers to and facilitators of oral intake and weight maintenance at 2 years after altered fractionation radiotherapy with concomitant boost (AFRT-CB). Twelve patients with T1-T3 oropharyngeal cancer who received AFRT-CB were assessed at baseline, 6 months, and 2 years post-treatment for levels of dysphagia and salivary toxicity, food and fluid tolerance, functional swallowing outcomes, patient-reported function, and weight. At 2 years, participants were also interviewed to explore barriers and facilitators of oral intake. Outcomes were significantly worse at 2 years when compared to baseline for late toxicity, functional swallowing, and patient-rated physical aspects of swallowing. Most patients (83%) tolerated a full diet pretreatment, but the rate fell to 42% (remainder tolerated soft diets) at 2 years. Multiple barriers to oral intake that impacted on activity and participation levels were identified. Participants lost 11 kg from baseline to 2 years, which was not regained between 6 months and 2 years. Global, social, and emotional domains of patient-reported function returned to pretreatment levels. At 2 years post AFRT-CB, worsening salivary and dysphagia toxicity, declining functional swallowing, and multiple reported ongoing barriers to oral intake had a negative impact on participants' activity and participation levels relating to eating. These ongoing deficits contributed to significant deterioration in physical swallowing functioning determined by the MDADI. In contrast, patients perceived their broader functioning had improved at 2 years, suggesting long-term adjustment to ongoing swallowing deficits.