Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma.

Abstract

OBJECTIVES/HYPOTHESIS:

To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT).

STUDY DESIGN:

Retrospective patient analysis.

METHODS:

A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling.

RESULTS:

There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P < .0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P = .0001), 10.9 (P = .0049), and 7.5 (P = .0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P = .0007) lower mean MDADI composite than never smokers.

CONCLUSIONS:

Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes.

LEVEL OF EVIDENCE:

4 Laryngoscope, 127:842-848, 2017.

• Authors: Ryan P Goepfert, Jan S Lewin, Martha P Barrow, C David Fuller, Stephen Y Lai, Juhee Song, Brian P Hobbs, G Brandon Gunn, Beth M Beadle, David I Rosenthal, Adam S Garden, Merrill S Kies, Vali A Papadimitrakopoulou, David L Schwartz, Katherine A Hutcheson
• Journal: The Laryngoscope (Laryngoscope) Vol. 127 Issue 4 Pg. 842-848 (04 2017) ISSN: 1531-4995 [Electronic] United States
• PMID: 27440393 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
• Copyright: © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Topics

• Adult
• Aged
• Cancer Care Facilities
• Carcinoma (mortality, pathology, radiotherapy)
• Databases, Factual
• Deglutition Disorders (epidemiology, etiology, physiopathology)
• Disease-Free Survival
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Invasiveness (pathology)
• Neoplasm Staging
• Oropharyngeal Neoplasms (mortality, pathology, radiotherapy)
• Predictive Value of Tests
• Prognosis
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Retrospective Studies
• Risk Assessment
• Self Report
• Survival Rate
• Time Factors
• United States