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Dysphagia

pp 1–10 | Cite as

Optimising Radiation Therapy Dose to the Swallowing Organs at Risk: An In Silico Study of feasibility for Patients with Oropharyngeal Tumours

  • Molly K. BarnhartEmail author
  • Bena Cartmill
  • Elizabeth C. Ward
  • Elizabeth Brown
  • Jonathon Sim
  • George Saade
  • Sandra Rayner
  • Rachelle A. Robinson
  • Virginia A. Simms
  • Robert I. Smee
Original Article
  • 5 Downloads

Abstract

Recent evidence suggests that reducing radiotherapy dose delivered to specific anatomical swallowing structures [Swallowing Organs at Risk (SWOARs)] may improve swallowing outcomes post-treatment for patients with head and neck cancer. However, for those patients with tumours of the oropharynx, which typically directly overlap the SWOARs, reducing dose to these structures may be unachievable without compromising on the treatment of the disease. To assess the feasibility of dose reduction in this cohort, standard IMRT plans (ST-IMRT) and plans with reduced dose to the SWOARs (SW-IMRT) were generated for 25 oropharyngeal cancer patients (Brouwer et al. in Radiother Oncol 117(1):83–90,  https://doi.org/10.1016/j.radonc.2015.07.041, 2015; Christianen et al. in Radiother Oncol 101(3):394–402,  https://doi.org/10.1016/j.radonc.2011.05.015, 2011). ST-IMRT and SW-IMRT plans were compared for: mean dose to the SWOARs, volume of pharynx and larynx receiving 50 Gy and 60 Gy (V50 and V60 respectively) and overlap between the tumour volume and the SWOARs. Additionally, two different SWOARs delineation guidelines (Brouwer et al. in Radiother Oncol 117(1):83–90,  https://doi.org/10.1016/j.radonc.2015.07.041, 2015; Christianen et al. in Radiother Oncol 101(3):394–402,  https://doi.org/10.1016/j.radonc.2011.05.015, 2011) were used to highlight differences in calculated volumes between existing contouring guidelines. Agreement in SWOARs volumes between the two guidelines was calculated using a concordance index (CI). Despite a large overlap between the tumour and SWOARs, significant (p < 0.05) reductions in mean dose to 4 of the 5 SWOARs, and V50/V60 for the pharynx and larynx were achieved with SW-IMRT plans. Low CIs per structure (0.15–0.45) were found between the two guidelines highlighting issues comparing data between studies when different guidelines have been used (Hawkins et al. in Semin Radiat Oncol 28(1):46–52,  https://doi.org/10.1016/j.semradonc.2017.08.002, 2018; Brodin et al. in Int J Radiat Oncol Biol Phys 100(2):391–407,  https://doi.org/10.1016/j.ijrobp.2017.09.041, 2018). This study found reducing dose to the SWOARs is a feasible practice for patients with oropharyngeal cancer. However, future prospective research is needed to determine if the extent of dose reduction achieved equates to clinical benefits.

Keywords

Head and neck cancer Radiation therapy planning Swallowing organs at risk Dose optimisation Dysphagia 

Notes

Acknowledgements

The authors wish to thank the speech pathology department and radiation therapy department at the Prince of Wales Hospital and Princess Alexandra Hospital for their contributions and support to this project. This project was funded by the Head and Neck Cancer Research Fund at Prince of Wales Hospital, Sydney Australia.

Funding

This project was funded by the Head and Neck Cancer Research Fund at Prince of Wales Hospital, Sydney Australia.

Compliance with Ethical Standards

Conflict of interest

All authors declares that he/she has no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Molly K. Barnhart
    • 1
    • 2
    Email author
  • Bena Cartmill
    • 3
    • 4
  • Elizabeth C. Ward
    • 2
    • 3
  • Elizabeth Brown
    • 5
  • Jonathon Sim
    • 6
  • George Saade
    • 6
  • Sandra Rayner
    • 6
  • Rachelle A. Robinson
    • 1
  • Virginia A. Simms
    • 1
  • Robert I. Smee
    • 6
    • 7
  1. 1.Speech Pathology DepartmentPrince of Wales Hospital (POWH)SydneyAustralia
  2. 2.School of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaAustralia
  3. 3.Centre for Functioning and Health Research, Metro South Hospital and Health ServiceQueensland HealthBurandaAustralia
  4. 4.Speech Pathology, Princess Alexandra Hospital, Metro South Hospital and Health ServiceQueensland HealthWoolloongabbaAustralia
  5. 5.Radiation Oncology, Princess Alexandra Hospital, Metro South Hospital and Health ServiceQueensland HealthWoolloongabbaAustralia
  6. 6.Radiation Oncology, Nelune Comprehensive Cancer CentrePOWHSydneyAustralia
  7. 7.The Clinical Teaching SchoolUniversity New South WalesKensingtonAustralia

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