Intensity modulated radiotherapy (IMRT) in the management of locally advanced oropharyngeal squamous cell carcinomata (SCC): disease control and functional outcome using the therapy outcome measure (TOM) score--report from a single U.K. institution

Charlotte J Ingle, Kent Yip, Valerie Caskie, Catherine Dyson, Amanda Ford, Christopher D Scrase, Charlotte J Ingle, Kent Yip, Valerie Caskie, Catherine Dyson, Amanda Ford, Christopher D Scrase

Abstract

Introduction: This paper evaluates tumour control and toxicity especially in relation to swallowing dysfunction in those patients with locally advanced oropharyngeal squamous cell carcinoma who have undergone either primary chemo-radiation or post-operative parotid sparing IMRT. The TOM scoring system was used to assess dysphagia.

Methods: All patients with locally advanced (stage 3/4) squamous cell oropharyngeal cancer and who required either primary or post-operative RT were identified. Toxicity was recorded prospectively. The TOM score (0-5 where 5 indicates that the patient is able to eat a normal diet and 0-2 varying degrees of enteral feeding dependency), weights and trismus was recorded immediately prior to and following radiotherapy.

Results: 24 patients were identified between 1/2003 and 11/2007. Median weight loss during radiotherapy was 9 kg. All but one patient had a gastrostomy (RIG) tube inserted prophylactically. With a mean follow-up of 37.1 months, 62.5% of pts had a TOM score of 5, 12.5% scored 3, 8% scored and 17% scored 0-2. For those patients whose swallowing function did recover, it took on average 8.7 months. 15% patients experienced trismus secondary to radiotherapy. 2 year overall survival was 92% and disease specific survival 96%.

Conclusion: Excellent disease control with intensified schedules of radiotherapy with IMRT has been achieved in this patient population. Intermediate toxicity is significant but with longer follow-up, dysphagia continues to improve with 75% of patients not requiring any form of enteral or oral supplementation.

Figures

Figure 1
Figure 1
Graph illustrating the recovery of TOM score over time for patients who recovered to at least their baseline swallowing function (n = 15) (Shaded area represents time during radiotherapy)
Figure 2
Figure 2
Graph illustrating the recovery of TOM score over time for patients who did not recover their baseline swallowing function (n = 9)
Figure 3
Figure 3
Kaplan Maier curve showing overall survival probability (%) against time (months)

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