Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy.
Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in "Low-Intermediate Risk" Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy.
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DOI：
10.1016/j.ijrobp.2016.06.010
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发表时间：
2017-03-15
影响因子：
7
通讯作者：
Hutcheson, Katherine A.
中科院分区：
文献类型：
--
作者：
Goepfert, Ryan P.;Lewin, Jan S.;Barrow, Martha P.;Gunn, G. Brandon;Fuller, C. David;Beadle, Beth M.;Garden, Adam S.;Rosenthal, David I.;Kies, Merrill S.;Papadimitrakopoulou, Vassiliki;Lai, Stephen Y.;Gross, Neil D.;Schwartz, David L.;Hutcheson, Katherine A.
我们的目标是对符合当前试验(例如ECOG 3311、NRG HN002、CRUK PATHOS)的口咽癌(OPC)患者在初次调强放疗(IMRT)后的长期M.D.Anderson吞咽困难清单(MDADI)结果进行表征。一项结合三个单一机构的晚期头颈癌临床试验数据的回溯性汇集分析。纳入标准为临床III/IV期OPC(T1-2/N1-2b，T3/N0-2b)，接受明确的分裂野调强治疗，并在基线和试验数据库中至少有一个治疗后间隔可用预期收集的MDADI。患者被抽样以代表可能的HPV相关疾病(HPV+/p16+或<；如果HPV/p16未知，则为10个包年)。在基线、治疗后6个月、12个月和24个月收集MDADI综合评分。对配对测试进行Bonferroni校正，以进行多次比较。共纳入46例患者。所有患者均接受双侧颈部照射，中位剂量为70Gy，同时接受全身治疗(57%同时进行，43%仅接受诱导治疗)。总体而言，平均基线MDADI综合评分为90.1分，在6个月时下降到74.6分(p<；0.0001)，在12个月和24个月时分别上升到78.5(p<；0.0001)和83.1(p=0.002)，代表着6个月时MDADI评分有临床意义的下降，部分恢复到24个月(6对24个月，p=0.002)。在基线、6个月、12个月和24个月时，分别有4、11、15和9%的患者报告MDADI评分较差(综合评分为60分)。15%的患者在24个月的间隔时间内综合评分持续下降至少20分。“中低危”的OPC患者接受了喉/食道入口剂量优化的分裂野IMRT治疗，在长期的随访中极有可能报告恢复可接受的吞咽功能。仅有15%的患者在调强放疗后12个月或更长时间报告吞咽功能差和/或MDADI持续低落。这些数据可作为未来试验设计和终点解释的基准。这项研究试图描述口咽癌患者在初次调强放射治疗和系统治疗后MDADI的长期结果。大多数患者报告在基线(平均为90.1)时“最佳”吞咽(复合>；80)，在治疗后6、12和24个月分别下降到74.6、78.5和83.1。在治疗后12个月或更长时间，高达15%的患者报告“不良”吞咽(复合吞咽)和/或持续抑制≥20分。
Our objective was to characterize long-term M.D. Anderson Dysphagia Inventory (MDADI) results after primary intensity modulated radiation therapy (IMRT) for oropharyngeal carcinoma (OPC) among patients with “low-intermediate risk” OPC who would be eligible for current trials (e.g. ECOG 3311, NRG HN002, CRUK PATHOS). A retrospective pooled analysis combined data from three single-institution clinical trials for advanced stage head and neck carcinoma. Inclusion criteria were clinical stage III/IV OPC (T1-2/N1-2b, T3/N0-2b) treated with definitive split-field IMRT and prospectively-collected MDADI at baseline and at least one post-treatment interval available in trial databases. Patients were sampled to represent likely HPV-associated disease (HPV+/p16+ or <10 pack-years if HPV/p16 unknown). MDADI composite scores were collected at baseline, 6, 12, and 24 months after treatment. Pairwise tests were Bonferroni corrected for multiple comparisons. Forty-six patients were included. All received bilateral neck irradiation with a median dose of 70Gy and systemic therapy (57% concurrent, 43% induction only). Overall, the mean baseline MDADI composite score was 90.1, dropping to 74.6 at 6 months (p<0.0001) and rising to 78.5 (p<0.0001) and 83.1 (p=0.002) by 12 and 24 months relative to baseline, respectively, representing a clinically meaningful drop in MDADI scores at 6-months that partially recovers by 24 months (6 v 24-months, p=0.05). Poor MDADI scores (composite<60) were reported in 4, 11, 15 and 9% of patients at baseline, 6-, 12-, and 24-months, respectively. 15% of patients had a persistently depressed composite score by at least 20 points at the 24-month interval. “Low-intermediate risk” patients with OPC treated with laryngeal/esophageal inlet dose-optimized split-field IMRT are highly likely to report recovery of acceptable swallowing function in long-term follow-up. Only 15% report poor swallowing function and/or persistently depressed MDADI at 12 months or more after IMRT. These data serve as a benchmark future trial design and endpoint interpretation. This study sought to characterize long-term MDADI results after primary IMRT and systemic therapy for oropharyngeal carcinoma among patients with “low-intermediate risk” disease. Most patients reported “optimal” swallowing (composite >80) at baseline (mean 90.1), which dropped to 74.6, 78.5, and 83.1 at 6, 12, and 24 months after treatment, respectively. Up to 15% reported “poor” swallowing (composite <60) and/or persistently depressed MDADI by ≥20 points at 12 months or more after treatment.
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影响因子：
3.8
作者：
Owadally, Waheeda;Hurt, Chris;Evans, Mererid
通讯作者：
Evans, Mererid
DOI：
10.1002/hed.23275
发表时间：
2014-01-01
影响因子：
2.9
作者：
Hunter, Klaudia U.;Lee, Oliver E.;Eisbruch, Avraham
通讯作者：
Eisbruch, Avraham
影响因子：
2.6
作者：
Gillespie, MB;Brodsky, MB;Martin-Harris, B
通讯作者：
Martin-Harris, B
影响因子：
2.6
作者：
Cartmill, Bena;Cornwell, Petrea;Porceddu, Sandro
通讯作者：
Porceddu, Sandro
影响因子：
10.3
作者：
Fakhry, Carole;Westra, William H.;Gillison, Maura L.
通讯作者：
Gillison, Maura L.