Late dysphagia after IMRT for head and neck cancer and correlation with dose–volume parameters

Abstract Background and purpose Many head and neck cancer (HNC) survivors experience diminished quality of life due to radiation-induced dysphagia. The aim of this study was to investigate frequency, intensity and dose–volume dependency for late dysphagia in HNC patients treated with curative IMRT. Materials and methods Candidates for the study were 294 patients treated with primary IMRT from 2006 to 2010; a total of 259 patients accepted to participate by answering the EORTC QLQ-C30 and H&N35 questionnaires. A total of 65 patients were further examined with modified barium swallow (MBS) and saliva collection. Data on patient, tumor and treatment characteristics were prospectively recorded in the DAHANCA database. Dose–volume histograms (DVH) of swallowing-related structures were retrospectively analyzed. Results QoL data showed low degree of dysphagia (QoL subscales scores of 17 and below) compared to objective measures. The most frequent swallowing dysfunction was retention; penetration and aspiration was less common. In general, objective measurements and observer-assessed late dysphagia correlated with dose to pharyngeal constrictor muscles (PCM), whereas QoL endpoints correlated with DVH parameters in the glottis/supraglottic larynx. Both xerostomia and dysphagia has been reduced after introduction of IMRT. Conclusions Radiation-induced dysphagia is still important, with a high degree of retention and penetration. Introduction of parotid-sparing IMRT has reduced the severity of dysphagia, primarily through a major reduction in xerostomia. Dose–response relationships were found for specific dysphagia endpoints.