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:
https://lup.lub.lu.se/record/4379678
- author
- Lindblom, Ulrika
LU
; Gärskog, Ola
; Kjellén, Elisabeth
LU
; Laurell, Göran
; Levring Jäghagen, Eva
; Wahlberg, Peter
LU
; Zackrisson, Björn
and Nilsson, Per
LU
- organization
- publishing date
- 2014
- 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
- 2016-04-01 10:29:16
- date last changed
- 2022-03-12 06:19:10
@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}},
doi = {{10.3109/0284186X.2014.892209}},
volume = {{53}},
year = {{2014}},
}