Cargando…
Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem
PURPOSE: Dysphagia is a common toxicity after head and neck (HN) radiation therapy that negatively affects quality of life. We explored the relationship between radiation therapy dose to normal HN structures and dysphagia 1 year after treatment using image-based datamining (IBDM), a voxel-based anal...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier, Inc
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10581448/ https://www.ncbi.nlm.nih.gov/pubmed/37331569 http://dx.doi.org/10.1016/j.ijrobp.2023.06.004 |
_version_ | 1785145975196614656 |
---|---|
author | Vasquez Osorio, Eliana Abravan, Azadeh Green, Andrew van Herk, Marcel Lee, Lip Wai Ganderton, Deborah McPartlin, Andrew |
author_facet | Vasquez Osorio, Eliana Abravan, Azadeh Green, Andrew van Herk, Marcel Lee, Lip Wai Ganderton, Deborah McPartlin, Andrew |
author_sort | Vasquez Osorio, Eliana |
collection | PubMed |
description | PURPOSE: Dysphagia is a common toxicity after head and neck (HN) radiation therapy that negatively affects quality of life. We explored the relationship between radiation therapy dose to normal HN structures and dysphagia 1 year after treatment using image-based datamining (IBDM), a voxel-based analysis technique. METHODS AND MATERIALS: We used data from 104 patients with oropharyngeal cancer treated with definitive (chemo)radiation therapy. Swallow function was assessed pretreatment and 1 year posttreatment using 3 validated measures: MD Anderson Dysphagia Inventory (MDADI), performance status scale for normalcy of diet (PSS-HN), and water swallowing test (WST). For IBDM, we spatially normalized all patients’ planning dose matrices to 3 reference anatomies. Regions where the dose was associated with dysphagia measures at 1 year were found by performing voxel-wise statistics and permutation testing. Clinical factors, treatment variables, and pretreatment measures were used in multivariable analysis to predict each dysphagia measure at 1 year. Clinical baseline models were found using backward stepwise selection. Improvement in model discrimination after adding the mean dose to the identified region was quantified using the Akaike information criterion. We also compared the prediction performance of the identified region with a well-established association: mean doses to the pharyngeal constrictor muscles. RESULTS: IBDM revealed highly significant associations between dose to distinct regions and the 3 outcomes. These regions overlapped around the inferior section of the brain stem. All clinical models were significantly improved by including mean dose to the overlap region (P ≤ .006). Including pharyngeal dosimetry significantly improved WST (P = .04) but not PSS-HN or MDADI (P ≥ .06). CONCLUSIONS: In this hypothesis-generating study, we found that mean dose to the inferior section of the brain stem is strongly associated with dysphagia 1 year posttreatment. The identified region includes the swallowing centers in the medulla oblongata, providing a possible mechanistic explanation. Further work including validation in an independent cohort is required. |
format | Online Article Text |
id | pubmed-10581448 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier, Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-105814482023-11-15 Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem Vasquez Osorio, Eliana Abravan, Azadeh Green, Andrew van Herk, Marcel Lee, Lip Wai Ganderton, Deborah McPartlin, Andrew Int J Radiat Oncol Biol Phys Physics Contribution PURPOSE: Dysphagia is a common toxicity after head and neck (HN) radiation therapy that negatively affects quality of life. We explored the relationship between radiation therapy dose to normal HN structures and dysphagia 1 year after treatment using image-based datamining (IBDM), a voxel-based analysis technique. METHODS AND MATERIALS: We used data from 104 patients with oropharyngeal cancer treated with definitive (chemo)radiation therapy. Swallow function was assessed pretreatment and 1 year posttreatment using 3 validated measures: MD Anderson Dysphagia Inventory (MDADI), performance status scale for normalcy of diet (PSS-HN), and water swallowing test (WST). For IBDM, we spatially normalized all patients’ planning dose matrices to 3 reference anatomies. Regions where the dose was associated with dysphagia measures at 1 year were found by performing voxel-wise statistics and permutation testing. Clinical factors, treatment variables, and pretreatment measures were used in multivariable analysis to predict each dysphagia measure at 1 year. Clinical baseline models were found using backward stepwise selection. Improvement in model discrimination after adding the mean dose to the identified region was quantified using the Akaike information criterion. We also compared the prediction performance of the identified region with a well-established association: mean doses to the pharyngeal constrictor muscles. RESULTS: IBDM revealed highly significant associations between dose to distinct regions and the 3 outcomes. These regions overlapped around the inferior section of the brain stem. All clinical models were significantly improved by including mean dose to the overlap region (P ≤ .006). Including pharyngeal dosimetry significantly improved WST (P = .04) but not PSS-HN or MDADI (P ≥ .06). CONCLUSIONS: In this hypothesis-generating study, we found that mean dose to the inferior section of the brain stem is strongly associated with dysphagia 1 year posttreatment. The identified region includes the swallowing centers in the medulla oblongata, providing a possible mechanistic explanation. Further work including validation in an independent cohort is required. Elsevier, Inc 2023-11-15 /pmc/articles/PMC10581448/ /pubmed/37331569 http://dx.doi.org/10.1016/j.ijrobp.2023.06.004 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Physics Contribution Vasquez Osorio, Eliana Abravan, Azadeh Green, Andrew van Herk, Marcel Lee, Lip Wai Ganderton, Deborah McPartlin, Andrew Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title | Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title_full | Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title_fullStr | Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title_full_unstemmed | Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title_short | Dysphagia at 1 Year is Associated With Mean Dose to the Inferior Section of the Brain Stem |
title_sort | dysphagia at 1 year is associated with mean dose to the inferior section of the brain stem |
topic | Physics Contribution |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10581448/ https://www.ncbi.nlm.nih.gov/pubmed/37331569 http://dx.doi.org/10.1016/j.ijrobp.2023.06.004 |
work_keys_str_mv | AT vasquezosorioeliana dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT abravanazadeh dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT greenandrew dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT vanherkmarcel dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT leelipwai dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT gandertondeborah dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem AT mcpartlinandrew dysphagiaat1yearisassociatedwithmeandosetotheinferiorsectionofthebrainstem |