Advanced

Dose-volume analysis of radiation-induced trismus in head and neck cancer patients

Gebre-Medhin, Maria LU ; Haghanegi, Mahnaz; Robért, Lotta; Kjellén, Elisabeth LU and Nilsson, Per LU (2016) In Acta Oncologica 55(11). p.1313-1317
Abstract

Introduction: Trismus is a treatment-related late side effect in patients treated for cancer in the head and neck region (HNC). The condition can have a considerable negative impact on nutrition, dental hygiene, ability to speak and quality of life. We have previously studied trismus within the frame of a randomized phase 3 study of HNC patients treated with mainly three-dimensional (3D) conformal radiotherapy (CRT) and found a strong association to mean radiation dose to the mastication muscles, especially the ipsilateral masseter muscle (iMAS). In the present study we have investigated trismus prevalence and risk factors in a more recent cohort of patients, treated with todays’ more updated radiation techniques. Material and methods:... (More)

Introduction: Trismus is a treatment-related late side effect in patients treated for cancer in the head and neck region (HNC). The condition can have a considerable negative impact on nutrition, dental hygiene, ability to speak and quality of life. We have previously studied trismus within the frame of a randomized phase 3 study of HNC patients treated with mainly three-dimensional (3D) conformal radiotherapy (CRT) and found a strong association to mean radiation dose to the mastication muscles, especially the ipsilateral masseter muscle (iMAS). In the present study we have investigated trismus prevalence and risk factors in a more recent cohort of patients, treated with todays’ more updated radiation techniques. Material and methods: Maximal interincisal distance (MID) was measured on 139 consecutive patients. Trismus was defined as MID ≤35 mm. Patient-, disease- and treatment-specific data were retrospectively recorded. Differences between groups were analyzed and mean absorbed dose to mastication structures was evaluated. Dosimetric comparisons were made between this study and our previous results. Results: The prevalence of trismus was 24% at a median of 16 months after completion of radiotherapy. In bivariate analysis treatment technique (3DCRT vs. intensity modulated radiotherapy or helical tomotherapy), tumor site (oropharynx vs. other sites) and mean radiation doses to the ipsilateral lateral pterygoid muscle, the paired masseter muscles and the iMAS were significantly associated with MID ≤35 mm. In multivariable analysis only mean radiation dose to the iMAS was significantly associated to MID ≤35 mm. Conclusion: Mean radiation dose to the ipsilateral masseter muscle is an important risk factor for trismus development. Dose reduction to this structure during radiotherapy should have a potential to diminish the prevalence of trismus in this patient group.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Oncologica
volume
55
issue
11
pages
5 pages
publisher
Taylor & Francis
external identifiers
  • scopus:84990943209
  • wos:000386374500009
ISSN
0284-186X
DOI
10.1080/0284186X.2016.1221129
language
English
LU publication?
yes
id
32027cac-1fa8-45fc-9438-9350eed54c32
date added to LUP
2016-10-28 10:14:13
date last changed
2017-11-19 04:34:19
@article{32027cac-1fa8-45fc-9438-9350eed54c32,
  abstract     = {<p>Introduction: Trismus is a treatment-related late side effect in patients treated for cancer in the head and neck region (HNC). The condition can have a considerable negative impact on nutrition, dental hygiene, ability to speak and quality of life. We have previously studied trismus within the frame of a randomized phase 3 study of HNC patients treated with mainly three-dimensional (3D) conformal radiotherapy (CRT) and found a strong association to mean radiation dose to the mastication muscles, especially the ipsilateral masseter muscle (iMAS). In the present study we have investigated trismus prevalence and risk factors in a more recent cohort of patients, treated with todays’ more updated radiation techniques. Material and methods: Maximal interincisal distance (MID) was measured on 139 consecutive patients. Trismus was defined as MID ≤35 mm. Patient-, disease- and treatment-specific data were retrospectively recorded. Differences between groups were analyzed and mean absorbed dose to mastication structures was evaluated. Dosimetric comparisons were made between this study and our previous results. Results: The prevalence of trismus was 24% at a median of 16 months after completion of radiotherapy. In bivariate analysis treatment technique (3DCRT vs. intensity modulated radiotherapy or helical tomotherapy), tumor site (oropharynx vs. other sites) and mean radiation doses to the ipsilateral lateral pterygoid muscle, the paired masseter muscles and the iMAS were significantly associated with MID ≤35 mm. In multivariable analysis only mean radiation dose to the iMAS was significantly associated to MID ≤35 mm. Conclusion: Mean radiation dose to the ipsilateral masseter muscle is an important risk factor for trismus development. Dose reduction to this structure during radiotherapy should have a potential to diminish the prevalence of trismus in this patient group.</p>},
  author       = {Gebre-Medhin, Maria and Haghanegi, Mahnaz and Robért, Lotta and Kjellén, Elisabeth and Nilsson, Per},
  issn         = {0284-186X},
  language     = {eng},
  month        = {11},
  number       = {11},
  pages        = {1313--1317},
  publisher    = {Taylor & Francis},
  series       = {Acta Oncologica},
  title        = {Dose-volume analysis of radiation-induced trismus in head and neck cancer patients},
  url          = {http://dx.doi.org/10.1080/0284186X.2016.1221129},
  volume       = {55},
  year         = {2016},
}