259 Acute swallowing outcomes in oropharyngeal cancers following clinical introduction of dysphagia-optimised IMRT (DO-IMRT) at a single tertiary centre
Notice bibliographique
Résumé
Swallowing dysfunction following curative (chemo) radiotherapy (RT) for head and neck cancers (HNC) is a significant treatment-related morbidity. Dysphagia-optimised IMRT (DO-IMRT) has recently shown to improve patient-reported swallowing outcomes, by reducing RT dose to dysphagia and aspiration -related structures. We implemented DO-IMRT in HNC patients undergoing primary radical RT-based treatment at our institution in August 2021. The objective of this retrospective analysis was to evaluate patient-reported and physician-scored acute swallowing toxicities in oropharyngeal squamous cell carcinoma (OPSCC) treated with DO-IMRT. Eligibility criteria included newly diagnosed OPSCC, treatment with primary radical DO-IMRT to the oropharynx and bilateral neck, alive and with no evidence of loco-regional recurrence at a minimum of 6 months following treatment completion. All patients received 65 Gy/30 fractions/6 weeks to the planning target volume (PTV1) of the tumour and involved nodes and 54 Gy/30 fractions/6 weeks to regions at risk of microscopic disease (PTV2) +/- chemotherapy as per institutional guidelines. Volumes of extended oral cavity, superior pharyngeal constrictor (PC), middle PC, inferior PC and larynx lying outside the PTVs were set optimal mean dose constraints of < 40 Gy, < 50 Gy, < 50 Gy, < 50 Gy, and < 30 Gy respectively during the optimisation process. Under-dosage of PTVs was not permitted to meet optimal dose constraints. Patients prospectively completed MD Anderson dysphagia inventory (MDADI), a patient-reported swallowing questionnaire, at baseline, week 6, 3 –, 6 –, 12 – and 24 months following treatment completion and a composite MDADI score for each point was generated. Prospective physician-scored toxicities using CTCAE v5.0 were also recorded at the above timepoints. This analysis evaluated swallowing outcomes measures upto 6 months post-RT. Descriptive statistics were used to report results. 47/56 OPSCC patients treated between August 2021 and February 2023 met the eligibility criteria. Baseline patient and tumour characteristics are presented in table 1. Majority of tumours were stage IV (AJCC 7thedition), human papillomavirus-associated, and treated with concomitant CRT. Mean (SD) composite MDADI scores at baseline, week 6, 3- and 6- months post treatment were 84 (15.0), 55.4 (12.8), 66.1 (18.3) and 73.1 (19.1) respectively (Table 2). Compared to baseline, 7 % and 11 % of patients reported a 10-point (clinically significant) improvement in composite MDADI score at 3 and 6 months respectively. The proportion of patients recording a clinically significant worse score was 87 %, 67 % and 53 % at week 6, and at 3- and 6 – months. 18 (38 %) patients required feeding tube (FT) insertion. 2 (4 %) patients were FT- dependent at 6 months. Majority of patients (81 %) had < grade 2 dysphagia at 6 months. FT-dependence in this initial cohort of OPSCC patients treated with DO-IMRT at our centre is low and compares favourably to contemporary data. Swallowing-related quality of life outcomes appear promising, with incremental improvements at 3- and 6-months post treatment. Future work includes assessment of longitudinal toxicity data, and the relationship between RT dose swallowing structures and toxicity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».