Lingual Strength & Dysphagia after Oropharynx Cancer: Proton vs. Photon Radiation

语言力量

• 批准号: 9103047
• 负责人: Katherine Arnold Hutcheson
• 金额: $ 8万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9103047
• 关键词: Acute; Address; Affect; Aftercare; Anterior; Biological Preservation; Cancer Survivor; Cancer Survivorship; Chronic; Clinical Trials; Correlative Study; Coupled; Data; Deglutition; Deglutition Disorders; Diagnosis; Diet; Dose; Dose-Limiting; Eastern Cooperative Oncology Group; Enrollment; Exercise; Head and Neck Cancer; Head and neck structure; Health; Institutional Review Boards; Intensity-Modulated Radiotherapy; Knowledge; Larynx; Life; Malignant Neoplasms; Measures; Methods; Mucositis; Oral cavity; Oropharyngeal; Oropharyngeal Squamous Cell Carcinoma; Outcome; Parents; Pathology; Patients; Phase; Phase II/III Trial; Photons; Pneumonia; Prevention; Preventive; Proton Radiation; Protons; Publishing; Quality of life; Radiation; Radiation Therapy Oncology Group; Radiation therapy; Randomized; Risk; Structure; Subgroup; Survivors; Techniques; Tongue; Toxic effect; Translating; Work; base; head and neck cancer patient; malignant oropharynx neoplasm; novel; proton therapy

 DESCRIPTION (provided by applicant): Dysphagia is a dose-limiting toxicity of radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC), and is the primary functional endpoint of contemporary oropharyngeal cancer trials (e.g., RTOG-1221, ECOG-3311). Conformal methods of radiation delivery hold promise to lessen the burden of dysphagia by minimizing dose to dysphagia-aspiration related structures (DARS). Recent work has focused on dose to the pharyngeal constrictors and larynx as a driver of dysphagia, but emerging data suggest the importance of oral cavity dose to swallowing outcomes. Lingual strength correlates with aspiration and swallowing endpoints in healthy subjects and patients with dysphagia, and our published data show that radiation dose to the anterior oral cavity predicts for long-term dysphagia after oropharyngeal intensity modulated photon therapy (commonly referred to as IMRT). Dose trade-offs required in IMRT plans using photon beams have been shown by our collaborators to result in elevated doses to the anterior oral cavity. This is thought to contribut to a greater degree of acute mucositis and predispose to chronic dysphagia despite other dose advantages of IMRT. Proton radiation (IMPT) is proposed as a novel method to de-escalate oropharyngeal RT by reducing collateral radiation dose to uninvolved normal structures adjacent to target volumes that are largely unavoidable with traditional IMRT using photon beams. Our preliminary data support a specific dose advantage with proton therapy (IMPT) to the region of the anterior oral cavity. We hypothesize that the oral cavity dose advantage with proton therapy (IMPT) translates to functional advantages over photon therapy (IMRT) in lingual strength, and ultimately in swallowing outcome. Thus, the primary objective of this application is to establish the relationship between RT technique (IMPT versus IMRT), anterior oral cavity dose, and lingual strength as they contribute to radiation-associated dysphagia after OPSCC. In this application, we propose to conduct correlative studies in a subgroup of patients enrolled on a parent randomized radiotherapy clinical trial. The investigative team has developed an IRB-approved, activated randomized phase II/III trial of IMPT versus IMRT for oropharyngeal cancer that will examine primary toxicity and survival endpoints. In this R03 application, we propose to prospectively examine three correlative questions in a subgroup of patients enrolled in the phase II portion of this trial: 1) is lingual strength better after IMPT vs. IMRT, 2) does anterior oral cavity dose correlate with lingual strength after highly conformal oropharyngeal RT, and 3) does lingual strength correlate with dysphagia after highly conformal oropharyngeal RT?

 描述（由申请人提供）：吞咽困难是口咽鳞状细胞癌（OPSCC）放疗的剂量限制性毒性，并且是当代口咽癌试验（例如RTOG-1221、ECOG-3311）的主要功能终点。适形放射治疗方法有望通过最大限度地减少吞咽困难误吸相关结构 (DARS) 的剂量来减轻吞咽困难的负担。最近的工作重点是咽缩肌和喉部的剂量作为吞咽困难的驱动因素，但新的数据表明口腔剂量对吞咽结果的重要性。健康受试者和吞咽困难患者的舌力与误吸和吞咽终点相关，我们发表的数据显示，前口腔的辐射剂量可预测口咽调强光子治疗（通常称为 IMRT）后的长期吞咽困难。我们的合作者已经证明，使用光子束的 IMRT 计划中所需的剂量权衡会导致前口腔的剂量增加。尽管 IMRT 具有其他剂量优势，但这被认为会导致更严重的急性粘膜炎并导致慢性吞咽困难。质子辐射 (IMPT) 被提出作为一种降低口咽放疗水平的新方法，通过减少对目标体积附近未受累正常结构的附带辐射剂量，使用光子束的传统 IMRT 在很大程度上不可避免地避免了这种情况。我们的初步数据支持质子治疗 (IMPT) 对前口腔区域的特定剂量优势。我们假设质子治疗 (IMPT) 的口腔剂量优势转化为相对于光子治疗 (IMRT) 的舌强度和最终吞咽结果方面的功能优势。因此，本申请的主要目的是建立 RT 技术（IMPT 与 IMRT）、前口腔剂量和舌力量之间的关系，因为它们会导致 OPSCC 后放射相关的吞咽困难。在本申请中，我们建议对参加父母随机放射治疗临床试验的患者亚组进行相关研究。研究小组开发了一项 IRB 批准的、启动的 IMPT 与 IMRT 治疗口咽癌的随机 II/III 期试验，该试验将检查主要毒性和生存终点。在此 R03 申请中，我们建议前瞻性地检查参加本试验 II 期部分的患者亚组中的三个相关问题：1) IMPT 与 IMRT 相比，舌侧力量是否更好，2) 前牙是否更好？ 口腔剂量与高度适形口咽放疗后的舌力量相关，3) 舌力量与高度适形口咽放疗后的吞咽困难相关吗？

项目成果

What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients?

• DOI: 10.1002/lary.25778
• 发表时间: 2016-05
• 期刊: The Laryngoscope
• 作者: Hutcheson KA;Barrow MP;Lisec A;Barringer DA;Gries K;Lewin JS
• 通讯作者: Lewin JS

Refining measurement of swallowing safety in the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) criteria: Validation of DIGEST version 2.

• DOI: 10.1002/cncr.34079
• 发表时间: 2022-04-01
• 期刊: Cancer
• 影响因子: 6.2
• 作者: Hutcheson KA;Barbon CEA;Alvarez CP;Warneke CL
• 通讯作者: Warneke CL

Expiratory muscle strength training for radiation-associated aspiration after head and neck cancer: A case series.

• DOI: 10.1002/lary.26845
• 发表时间: 2018-05
• 期刊: The Laryngoscope
• 作者: Hutcheson KA;Barrow MP;Plowman EK;Lai SY;Fuller CD;Barringer DA;Eapen G;Wang Y;Hubbard R;Jimenez SK;Little LG;Lewin JS
• 通讯作者: Lewin JS