(P096) Late Radiation-Associated Dysphagia (Late-RAD) With Lower Cranial Neuropathy After Oropharyngeal IMRT

OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Although the majority of oropharyngeal cancer survivors enjoy functional recovery in early survivorship, almost 10% suffer severe, late deterioration of swallowing abilities. Delayed lower cranial neuropathies often precipitate late-RAD.

Katherine A. Hutcheson, PhD, Denise A. Barringer, MS, CCCSLP, G. Brandon Gunn, MD, Stephen Y. Lai, MD, Merrill S. Kies, MD, David L. Schwartz, MD, Jan S. Lewin, PhD; UT MD Anderson Cancer Center; UT Southwestern Medical Center

PURPOSE: Late radiation-associated dysphagia (late-RAD) is a debilitating, delayed toxicity of nonsurgical organ preservation for head and neck cancers. Herein, we examine late-RAD in long-term oropharyngeal cancer survivors after intensity-modulated radiation therapy (IMRT).

METHODS: A pooled dataset was analyzed from two institutional single-arm clinical trials of nonsurgical organ preservation with radiation. Prospective functional analysis included radiographic swallow studies (videofluoroscopy) and questionnaires pretreatment and 6, 12, and 24 months after treatment. Functional recovery at 1 year was assessed by index measure: solid food diet, feeding tube–free, functional airway protection, and no lower cranial neuropathy or stricture. A diagnostic algorithm was developed to classify late-RAD events based on significant dysphagia on late (≥ 2 yr) videofluoroscopic swallow referrals among patients with early functional recovery from acute toxicities of IMRT by 1 year.

RESULTS: A total of 57 oropharyngeal cancer survivors with a minimum 2-year disease-free clinical follow-up after IMRT (range: 66–72 Gy) with systemic therapy were included. T-stage distribution was: TX (4), T1 (13), T2 (21), T3 (15), and T4 (4). Also, 52 patients (91%) achieved functional recovery by 1 year. At a median follow-up of 5 years, the cumulative incidence of late-RAD was 9% (5 of 57), 3 of whom had delayed lower cranial neuropathy (XII or X). An additional five patients were considered at risk for late-RAD per self-report of progressive dysphagia symptoms ≥ 2 years after treatment without videofluoroscopic confirmation.

CONCLUSION: Although the majority of oropharyngeal cancer survivors enjoy functional recovery in early survivorship, almost 10% suffer severe, late deterioration of swallowing abilities. Delayed lower cranial neuropathies often precipitate late-RAD.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
Related Videos
Considering cystectomy in patients with bladder cancer may help with managing the shortage of Bacillus Calmette-Guerin, according to Joshua J. Meeks, MD, PhD, BS.
Anemia in patients who receive talazoparib plus enzalutamide for metastatic castration-resistant prostate cancer appears to be manageable without any compromises in patient-reported outcomes and quality of life.
Patients with locally advanced or metastatic urothelial cancer and visceral disease may particularly benefit from enfortumab vedotin plus pembrolizumab, according to Amanda Nizam, MD.
High-grade adverse effects with zanidatamab plus palbociclib and fulvestrant seem to be uncommon in patients with HER2-positive, hormone receptor–positive, metastatic breast cancer, according to Sara Hurvitz, MD, FACP.
Black male patients with breast cancer appear to experience worse survival outcomes compared with White patients when controlling for clinicopathological variables, according to Jason (Jincong) Q. Freeman, MPH, MS.
Results from the ECOG-ACRIN E4112 trial appear to support the use of DCIS scores for identifying patients with breast cancer who may be eligible to omit radiotherapy following MRI-guided surgery.
Providers should inform patients with breast cancer that selecting later-line therapies following prior treatment with CDK4/6 inhibitors is a “developing area,” says Abigail M. Johnston, JD.
Data from the phase 3 NATALEE trial highlight a positive toxicity profile for ribociclib as an adjuvant therapy for patients with hormone receptor–positive, HER2-negative breast cancer, says Neil M. Iyengar, MD.
Future research will focus on ctDNA dynamics change over time in the full translational cohort of patients with hormone receptor–positive breast cancer in the phase 3 monarchE study, says Stephanie L. Graff, MD.
Findings from a National Cancer Database analysis highlight no statistically significant differences in survival outcomes with chemotherapy for patients over 81 years old with triple-negative breast cancer compared with those who do not receive chemotherapy.
Related Content