Results of a randomised phase III trial of dysphagia-optimised intensity modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT) in head and neck cancer.
Session type: E-poster/poster
Most oro- and hypopharyngeal cancers (OPC, HPC) are treated with (chemo)radiotherapy with curative intent at the consequence of adverse effects on quality of life. DARS (CRUK/14/014; ISRCTN25458988) tested if using Do-IMRT to reduce radiation dose to the dysphagia/aspiration related structures (DARS) improved swallowing function compared to S-IMRT.
Patients (T1-4, N0-3, M0 OPC/HPC) were randomised (1:1) to S-IMRT (65 gray (Gy)/30 fractions (f) to primary and nodal tumour; 54Gy/30f to remaining pharyngeal subsite and nodal areas at risk of microscopic disease) or Do-IMRT. For Do-IMRT the volume of the superior and middle pharyngeal constrictor muscle (PCM) (OPC) or inferior PCM (HPC) lying outside the high-dose target volume had a mandatory mean dose constraint. Patients were blind to treatment allocation. Primary endpoint was MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after radiotherapy. Secondary endpoints included University of Washington (UW)-Qol, Performance Status Scale Head & Neck (PSS-HN) domain scores (range: 0-100), swallow volume, swallow capacity and local control.
112 patients were randomised from 22 UK centres from 06/2016-04/2018. Mean age was 57 years; 80% were male; 97% had OPC; 90% had AJCC stage 3&4 disease; 90% had concomitant chemotherapy. Radiation dose and outcome measures at 12 months are summarised below. Three local recurrences (1 S-IMRT, 2 Do-IMRT) were reported.
Do-IMRT reduced radiotherapy dose to the DARS and improved patient-reported swallowing function compared with S-IMRT.
Do-IMRT can improve quality of life for OPC patients requiring radiotherapy.