TY - JOUR
T1 - Late dysphagia after changes in high-dose clinical tumour volume margin for head and neck cancer patients
AU - Zukauskaite, Ruta
AU - Eriksen, Jesper Grau
AU - Johansen, Jørgen
AU - Samsøe, Eva
AU - Kristensen, Morten Horsholt
AU - Johnsen, Lars
AU - Lonkvist, Camilla Kjaer
AU - Grau, Cai
AU - Overgaard, Jens
AU - Hansen, Christian Rønn
PY - 2025/9/18
Y1 - 2025/9/18
N2 - BACKGROUND AND PURPOSE: One of the factors influencing disease control and toxicity risk after radiotherapy is selection of treatment volume margin. This study evaluates whether different gross tumour volume (GTV) to high-dose clinical target volume (CTV1) margins impact dysphagia in a cohort of head and neck squamous cell carcinoma (SCC) patients. Patient/material and methods: Data of patients receiving primary IMRT-based radiotherapy for SCC for the oropharynx, hypopharynx, and larynx at three treatment centres between 2010 and 2015 were retrospectively collected. Treatment planning followed two DAHANCA guideline periods: pre-2013 (varying GTV-CTV1 margins), and post-2013 (isotropic 5 mm margin). Treatment plans were collected for 1,913 patients. GTV-CTV1 margins were calculated as median surface distance from GTV to CTV1. Dysphagia was graded using modified DAHANCA ordinal scale. For each patient, the highest score of dysphagia during 5-year follow-up period was chosen for analysis.RESULTS: Dysphagia data were available for 1,706 patients (89%). The median GTV-CTV1 margin was 9.0 mm in 2010-2012 and 4.7 mm in 2013-2015. The severity of dysphagia was more pronounced in patients treated during 2010-2012 (p = 0.003). Predictors of grade ≥ 2 dysphagia included larger GTV (odds ratio [OR]: 1.7; p < 0.001), larger GTV-CTV1 margin (odds ratio [OR] of 1.3 per cm; p = 0.04), and tumour localisation other than oropharyngeal p16+carcinomas (p = 0.002). Male sex, non/previous smoking status, and application of chemotherapy were associated with less severe dysphagia.INTERPRETATION: Tumour volume and GTV-CTV1 margin are dominant geometric parameters influencing dysphagia risk following curative radiotherapy.
AB - BACKGROUND AND PURPOSE: One of the factors influencing disease control and toxicity risk after radiotherapy is selection of treatment volume margin. This study evaluates whether different gross tumour volume (GTV) to high-dose clinical target volume (CTV1) margins impact dysphagia in a cohort of head and neck squamous cell carcinoma (SCC) patients. Patient/material and methods: Data of patients receiving primary IMRT-based radiotherapy for SCC for the oropharynx, hypopharynx, and larynx at three treatment centres between 2010 and 2015 were retrospectively collected. Treatment planning followed two DAHANCA guideline periods: pre-2013 (varying GTV-CTV1 margins), and post-2013 (isotropic 5 mm margin). Treatment plans were collected for 1,913 patients. GTV-CTV1 margins were calculated as median surface distance from GTV to CTV1. Dysphagia was graded using modified DAHANCA ordinal scale. For each patient, the highest score of dysphagia during 5-year follow-up period was chosen for analysis.RESULTS: Dysphagia data were available for 1,706 patients (89%). The median GTV-CTV1 margin was 9.0 mm in 2010-2012 and 4.7 mm in 2013-2015. The severity of dysphagia was more pronounced in patients treated during 2010-2012 (p = 0.003). Predictors of grade ≥ 2 dysphagia included larger GTV (odds ratio [OR]: 1.7; p < 0.001), larger GTV-CTV1 margin (odds ratio [OR] of 1.3 per cm; p = 0.04), and tumour localisation other than oropharyngeal p16+carcinomas (p = 0.002). Male sex, non/previous smoking status, and application of chemotherapy were associated with less severe dysphagia.INTERPRETATION: Tumour volume and GTV-CTV1 margin are dominant geometric parameters influencing dysphagia risk following curative radiotherapy.
KW - Humans
KW - Deglutition Disorders/etiology
KW - Male
KW - Female
KW - Retrospective Studies
KW - Middle Aged
KW - Aged
KW - Head and Neck Neoplasms/radiotherapy
KW - Radiotherapy, Intensity-Modulated/adverse effects
KW - Tumor Burden/radiation effects
KW - Squamous Cell Carcinoma of Head and Neck/radiotherapy
KW - Carcinoma, Squamous Cell/radiotherapy
KW - Radiotherapy Dosage
KW - Aged, 80 and over
KW - Adult
KW - Radiotherapy Planning, Computer-Assisted/methods
U2 - 10.2340/1651-226X.2025.43924
DO - 10.2340/1651-226X.2025.43924
M3 - Article
C2 - 40968403
SN - 0284-186X
VL - 64
SP - 1262
EP - 1268
JO - Acta Oncologica
JF - Acta Oncologica
ER -