Advanced

Radiation-induced trismus in the ARTSCAN head and neck trial.

Lindblom, Ulrika LU ; Gärskog, Ola; Kjellén, Elisabeth LU ; Laurell, Göran; Levring Jäghagen, Eva; Wahlberg, Peter LU ; Zackrisson, Björn and Nilsson, Per LU (2014) In Acta Oncologica 53(5). p.620-627
Abstract
Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. Material and methods. Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC... (More)
Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. Material and methods. Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite(®) range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. Results. No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. Conclusions. Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus. (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
53
issue
5
pages
620 - 627
publisher
Taylor & Francis
external identifiers
  • pmid:24669774
  • wos:000334740000007
  • scopus:84898889915
ISSN
1651-226X
DOI
10.3109/0284186X.2014.892209
language
English
LU publication?
yes
id
c4e0b20f-bb4b-432b-b378-461b90846392 (old id 4379678)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24669774?dopt=Abstract
date added to LUP
2014-04-04 19:48:53
date last changed
2017-03-05 03:11:23
@article{c4e0b20f-bb4b-432b-b378-461b90846392,
  abstract     = {Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. Material and methods. Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite(®) range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. Results. No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. Conclusions. Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensity-modulated radiation therapy will reduce problems with trismus.},
  author       = {Lindblom, Ulrika and Gärskog, Ola and Kjellén, Elisabeth and Laurell, Göran and Levring Jäghagen, Eva and Wahlberg, Peter and Zackrisson, Björn and Nilsson, Per},
  issn         = {1651-226X},
  language     = {eng},
  number       = {5},
  pages        = {620--627},
  publisher    = {Taylor & Francis},
  series       = {Acta Oncologica},
  title        = {Radiation-induced trismus in the ARTSCAN head and neck trial.},
  url          = {http://dx.doi.org/10.3109/0284186X.2014.892209},
  volume       = {53},
  year         = {2014},
}