symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors a cohort analysis 2017 angela t.t. wong资料.pdf

该【symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors a cohort analysis 2017 angela t.t. wong资料 】是由【小舍儿】上传分享，beplayapp体育下载一共【6】页，该beplayapp体育下载可以免费在线阅读，需要了解更多关于【symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors a cohort analysis 2017 angela t.t. wong资料 】的内容，可以使用beplayapp体育下载的站内搜索功能，选择自己适合的beplayapp体育下载，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此beplayapp体育下载到您的设备，方便您编辑和打印。OralOncology66(2017)75–80ContentslistsavailableatScienceDirectOralOncologyjournalhomepage:ate/oraloncologySymptomburdenanddysphagiaassociatedwithosteoradionecrosisinlong-termoropharynxcancersurvivors:,,b,,,,,,,,?AbdallahSherifRadwanMohamedc,,,aDepartmentofHeadandNeckSurgery,TheUniversityofTexasMDAndersonCancerCenter,Houston,TX,USAbDepartmentofMolecularandCellularOncology,TheUniversityofTexasMDAndersonCancerCenter,Houston,TX,USAcDepartmentofRadiationOncology,TheUniversityofTexasMDAndersonCancerCenter,Houston,TX,USAarticleinfoabstractArticlehistory:Objective:herelationshipbetweenmandibularosteoradionecrosis(ORN)andReceived4October2016chronicdysphagiainlong-termoropharynxcancer(OPC)survivors,:-pointclassi?,strictureoraspirationdetectedKeywords:by?uoroscopyorendoscopy,and/orfeedingtubedependenceinlong-termfollow-–HeadandNeckModule(MDASI-HN)scoreswereana-OropharynxcancerDysphagialyzedinanestedcross-:34(%,95%CI:–%)patientsdevelopedORNand45(%,95%CI:–%)?cantlyhigherinORNcasesSymptomburden(12/34,35%)comparedtothosewhodidnotdevelopORN(33/315,11%,p<).ORNgradewasalsoMorbiditysigni?cantlyassociatedwithprevalenceofdysphagia(p<);themajorityofpatientswithgrade4Patient-esORNrequiringmajorsurgery(6patients,75%)-HNsymptomscoresdidnotsigni??cantlyhighersymptombur-denwasreported,however,paredtothosewithoutORNforMDASI-HNswallow-ing(p=),ums(p=)andchangeinactivity(p=):ORNisassociatedwithexcessburdenofchronicdysphagiaandhighersymptomseverityrelatedtoswallowing,dentitionandactivitylimitations.ó-mavirus(HPV).HPV-positiveoropharyngealsquamouscellcarci-Theannualestimatedincidenceoforopharynxcancerisnomas()thathavebetterresponsetotreatmentandlowerapproximately130,300casesperyearworldwidewithanesti-mated15,000newcasesdiagnosedannuallyintheUnitedStates[3–5].[1,2].Overthelastfewdecades,theincidenceoforopharynxcan-primarilyinvolvesradiotherapyandcerhasbeenincreasingdramaticallyindevelopedcountriessuchchemotherapywiththegoalofpreservationofanatomyandfunc-astheUnitedStates,Canada,Australia,theUnitedKingdom,Den-tion[6].,radiationtherapymark,herlands,NorwayandSweden[3].Thisriseinthecaninducenormaltissuechangesthatcancauseamyriadofacuteplications[2].plicationscanincludeoralmucositis,increasedriskofinfections,xerostomia,neuro-?Correspondingauthorat:TheUniversityofTexasMDAndersonCancerCenter,pathicpain,osteoradionecrosis(ORN)anddysphagiawhichcanDepartmentofHeadandNeckSurgery,Unit1445,POBox301402,Houston,TXleadtosigni?cantmorbidityanddecreasedqualityoflifein77030,[2,6].E-mailaddress:karnold@().http://dx./.-8375/ó./OralOncology66(2017)75–80plicationsoftreatmentnecessitatingmajorsurgery[14].Timetoevent,initialstaging,–evolutionofstaging,%ofpatientstreatedwithprimaryradiotherapyorchemora-wastheprimarystrati?,whende?nedbychronicaspiration,Dysphagiameasuresastrostomydependence[6–8].Radiationdosedistributionstoswallowing-criticalmuscleregionsincludingtheChronicdysphagiapresentforP1yearwastheprimaryend-pharyngealconstrictors,suprahyoidmuscles,andthelarynxpri-[9–11].as(1)dependentonafeedingtube;(2)aspirationseenonamod-plicationofradiationtreat-i?edbariumswallow(MBS)or?(FEES);(3)?nitionofORNisananMBSorendoscopy;or(4)aspirationpneumoniawithradio-hatfailstohealafteraperiodof3months,graphicevidenceofin?ltrate[7].afterexclusionofallotherdiagnoses[12,13].Fortunately,ORNisplicationwithincreaseduseofCovariatesintensity-modulatedradiationtherapy(IMRT).DespiteadecliningrateofORN,therateisstillsigni?cantwithanestimatedincidenceOthervariablesthatcouldin?%inheadandneckcancerpatients[13].Amongtheriskfac-symptomburdenwereexaminedandincludeddemographicvari-torsforORN,themostsigni?cantarehighosseousradiationdoseablessuchasage,sex,raceandsmokingstatus,diseasevariablesdistributions,extractionofteethwithinthe?eldofradiation,suchastumorsubsite,TNMstaging,radiotherapyfractionationsmokingandalcoholconsumption[13–15].ORNcanmanifestasschedule,totalradiotherapydoseandnumberoffractions[8].Typeonditiontoseverelydebilitatingpresentationandtimingofsystemictherapy(inductionand/orconcurrentwithrelatedpain,dis?gurementandfunctionalimpairment[12].chemotherapyortargetedtherapy),,par-Symptomburdenassessmentticularlywithadvancedcasesrequiringmandibulectomywithremovalofthesymphysis,butgrouplevelassociationsbetweenSymptomburdenwasassessedviaamulti-symptominventory,dysphagiaandORNarelimited[16].Thepurposeofthisretrospec-theMDAndersonSymptomInventory–HeadandNeckModuleherelationshipbetweenORNandchronic(MDASI-HN)pleteddysphagiainlong-termoropharynxcancersurvivorsandtochar-theinventoryafterconsentingtoparticipationinaprospectivesur--HNisabrief28-itemmulti-symptominven-,demonstratinghighlevelsofreliabilityforeachsetofitems[17].Thereare13coreMaterialsandmethodsitemsrepresentinggeneralcancerrelatedsymptomsand9headandneckcancerspeci?citemsincludedintheMDASI-HNwhichStudydesignandeligibilitycriteriaaremouthsores,tastingfood,constipation,problemswithteethorgums,skinpain,voiceorspeechdif?culties,chokingorcough-Aretrospectivecohortstudywithnestedcross-sectionalsurveying,chewingorswallowingproblems,andincreasedmucussecre-analysiswasperformedtocharacterizethefunctionalburdenoftions[17].:(1)–10,from;(2)treatmentwithde?nitive‘‘notpresent”forsystemicandheadandnecksymptomsto‘‘asbadintensity-modulatedradiationtherapy(IMRT)andsystemicther-asyoucanimagine”orfrom‘‘didnotinterfere”-apy(inductionand/orconcurrentchemotherapyortargetedther-pletely”-HNsurveyspost-apy);and(3)aminimumof1-yeardiseasefreefollow-.(2016),with?nalinclusionof349patients[8].StatisticalmethodsAlleligiblepatientsweresampledfromaprospectiveepidemio-,--HNsummaryscores(totalsymptomburden,localsymptomburden,systemicsymptomStudyvariablesanddatasourceburden,andinterference)paredbetweengroupsbasedonORNstatususingtwo-samplet--AreviewoftheelectronicmedicalrecordwasusedtocollectBonferronicorrectedpvalueof<,orbidities,tumorandtreatmentsigni?,,(StataCorpLP,CollegeStation,TX).OsteoradionecrosismeasuresResultsordingtotreatmentbasedseverityclassi?-cationsystem?rstpublishedbyTsaietal.[14].Grade1ORNisParticipantsde?nedasminimalboneexposurerequiringconservativetreat-mentonly,grade2ORNreceivingminordebridement,-./OralOncology66(2017)75–,ppatients#ofpts(ORNrate%)value*SexMale31331()()RaceWhite32833()-White211()Age,y65619119()>5615815()SmokingstatusCurrent639()()Never15912()TClassi?cation1664()()37611()4455()=?()()3150(%)hadgrade4ORNnecessitatingmajorsurgery;6of8ulti-matelyunderwentmandibulectomy(2marginal,4segmental)()431932()ORNandchronicdysphagiaCancersubsiteBaseoftongue19017(),12(35%,95%CI:–%)?cantlyfewerofthepatientswithoutORNpalateTonsil15317()developeddysphagia(33/315,11%,95%CI:–%,p<).()(OR:,95%Concurrent16218()CI:–)?cantlyInduction+concurrent10210()associatedwiththeprevalenceofchronicdysphagia(p<).Adjuvant50IMRTscheduleOncedaily30731()()IMRTtechniqueSplit-?eld32831()?eld213()NeckdissectionafterIMRTNo27428()(8)Total34934*p-(%,95%CI:–%)developedORNwithamedianfollow-upof78months(minimumfollow-up:12months;IQR:60–101months).Table1outlinessex,race,age,smokingstatus,?cantdemographic,diseaseortreatmenttypepredictiveofORN(p>).moninpatientswithgreaterdiseaseburden,includingpatientswithT3orT4primarytumorsornode-positivedisease,butthesediffer-enceswerenotstatisticallysigni?-signi?cantpositivetrendwasalsoobservedwithsmokingstatusatbaselineanddevelopmentofORN(Wilcoxonnon-==).developedORN(OR:%CI:–,p<),,Prevalenceofdysphagiasigni?cantlydifferedbyORNgrade(p<),,35%(12/34)./OralOncology66(2017)75–80dysphagiadetectedbyclinicalevents(OR:,95%CI:–)andalsoasassessedbyapatient-einstrument(MDASI-HN).Previousstudieshaveaddressedtheassociationofdifferentmandibulardose-volumecorrelatesandvariouspermutationsofmaximumandmeandosewithORNdevelopment,butinpartbecauseoftherelativelylowincidenceofORN,itremainsunclearwhatdose-volumeparametersaremostsigni?cantlyassociatedplicationofradiationtherapy[13–15].Inacase-controlanalysisincludingpatientsfromthiscohort,dose-volumehistogram(parisonfoundthatmandibularmeandosewassigni?cantlyhigherintheORNcases()whilethemaximumdosewasnotsigni?cantlydifferent[18].ChronicdysphagiainOPCsurvivorsismostlikelywhe