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

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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
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