We use cookies necessary to giving you a better online experience. By using our website you consent to all cookies in accordance with our Privacy Policy.
Yes, I accept
Menu
Search Opener

Session Item

Saturday
August 28
08:00 - 08:40
N103
The role of RTT leadership in advancing multi-disciplinary research
Sophie Perryck, Switzerland
0070
Teaching lecture
RTT
09:17 - 09:25
Aspiration related OARs are relevant predictors of silent aspiration after (chemo)radiation.
PH-0042

Abstract

Aspiration related OARs are relevant predictors of silent aspiration after (chemo)radiation.
Authors: Gawryszuk|, Agata(1)*[a.gawryszuk@umcg.nl];van der Laan |, Hans Paul(1);Steenbakkers |, Roel J.M.(1);van den Hoek |, Johanna G.M.(1);Holwerda|, Moniqe(2);Verdonck-de Leeuw |, Irma M.(3);Rinkel|, Rico N.(3);Bijl|, Hendrik P.(1);Langendijk|, Johannes A.(1);
(1)University Medical Center Groningen- Groningen, Department of Radiation Oncology, Groningen, The Netherlands;(2)University Medical Center Groningen- Groningen, Department of Otolaryngology- Speech Language Pathology, Groningen, The Netherlands;(3)Amsterdam University Medical Center, Department of Otolaryngology – Head & Neck Surgery, Amsterdam, The Netherlands;
Show Affiliations
Purpose or Objective

Late (silent) aspiration, potentially leading to pneumonia, is one of the most hazardous complications after (chemo)radiation ((CH)RT) for head and neck cancer. Due to its silent nature, it can only be captured during objective examination. Videofluoroscopy (VF) is the golden standard. Radiation dose to the supraglottic larynx is known to be associated with aspiration, but the role of muscular dysfunction responsible for reduced hyolaryngeal elevation (= underlying mechanism of aspiration) is not widely assessed and addressed. The purpose of this analysis was to identify the best predictors of RT-induced silent aspiration captured on VF.

Material and Methods

This prospective cohort study included 189 head and neck cancer patients receiving definitive (CH)RT. Patients underwent a comprehensive dysphagia assessment (including VF) at baseline and 6 months after treatment. Three primary endpoints of silent aspiration (SA) were considered at 6 months after treatment. The endpoints corresponded to aspiration with 3 different bolus viscosities: liquid (SA_LIQ), pudding (SA_PUD) and solid (SA_SOL). SA was defined as a VF-based Penetration Aspiration Scale (PAS) score 8. Swallowing structures (SWOARs) and Functional Swallowing Units (FSUs) were delineated according to published and/or international consensus guidelines (Brouwer et al. 2015, Gawryszuk et al. 2019). Baseline features relevant for SA and average doses (Dmean) of all delineated structures were selected as candidate variables. Multivariable normal tissue complication probability (NTCP)-models were developed using logistic regression with bootstrapping, dealing with non-linear dose-effect relations and multicollinearity.

Results

The prevalence of SA_LIQ, SA_PUD, and SA_SOL were 19%, 17%, and 16%, respectively. The best performing models for the 3 endpoints included the following prognostic factors: SA_LIQ: Supraglottic Larynx (SG Dmean), Upper Esophageal Sphincter,  consisting of pharyngeal constrictor inferior, cricopharyngeal muscle and esophagus inlet muscle (UES Dmean), Anterior Complex, consisting of floor of mouth and thyrohyoid muscles (AC Dmean), disease stage 3-4; SA_PUD: SG Dmean, UES Dmean, disease stage 3-4; SA_SOL: SG Dmean, AC Dmean, disease stage 3-4. All models had good calibration and model performance (apparent ROC-AUC: 0.71, 0.79 and 0.82 respectively). Table 1.

Conclusion

Patients with more advanced disease are at the highest risk of silent aspiration for all bolus viscosities after (CH)RT. Beside the dose to the Supraglottic Larynx also the  dose to the UES and AC (Fig. 1) contribute to a greater risk of silent aspiration. Additional sparing of the Anterior Complex could potentially reduce the risk of silent aspiration after (CH)RT for head and neck cancer.