Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_44_3748 - Patient-Reported Dry Mouth After Radiation Therapy for Head and Neck Cancer: Dosimetric Analysis of Long-Term Outcomes

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patient-Reported Dry Mouth After Radiation Therapy for Head and Neck Cancer: Dosimetric Analysis of Long-Term Outcomes
M. Kamal1,2, D. I. Rosenthal1, S. Volpe1,3, R. P. Goepfert1, A. S. Garden1, K. A. Hutcheson1, S. Eraj1, A. Dursteler1,4, B. Williams1, J. Smith1, J. Aymard5, J. Berends6, A. White1, B. O'Donnell1, S. J. Frank1, W. H. Morrison1, R. Cardoso1, M. S. Chambers1, E. M. Sturgis1, T. R. Mendoza1, C. E. Cardenas1, H. D. Skinner7, J. Phan8, A. S. Mohamed1,9, C. D. Fuller1,10, and G. B. Gunn1; 1The University of Texas MD Anderson Cancer Center, Houston, TX, 2Clinical Oncology and Nuclear Medicine Department, Ain Shams University, Cairo, Egypt, 3University of Milan, Department of Hemato-Oncology, Milan, Italy, 4McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 5Abilene Christian University, Houston, TX, 6The University of Texas Health Science Center San Antonio, San Antonio, TX, 7Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 8Dept. of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 9Clinical Oncology and Nuclear Medicine Department, Alexandria University, Alexandria, Egypt, 10University of Texas Graduate School of Biomedical Sciences, Houston, TX

Purpose/Objective(s): To assess the association between long-term patient-reported dry mouth (DM) and dosimetric parameters of major and minor salivary glands in head and neck cancer (HNC) survivors after radiotherapy (RT)

Materials/Methods: Disease-free HNC survivors were eligible for participation in patient-reported outcome questionnaire-based assessment who completed the MD Anderson Symptom Inventory-Head and Neck-(MDASI-HN). For this study, we considered the dry mouth item (DM) of the MDASI-HN for participants with a minimum of 21 months after RT. We used a previously defined QOL altering DM threshold score of ≥6 (0-10 point scale) to group patients by DM severity (low: <6; high: ≥6). Dose-volume histograms (DVH) for the salivary regions of interest (ROIs) were calculated for each symptom group: ipsi-/contra-lateral parotid glands (PGs), ipsi-/contra-lateral (C) submandibular glands (SMGs), and extended oral cavity mucosa (EOCM). Mean doses (Dmean) to each ROI for those reporting severe DM were compared to those with less severity using Wilcoxon rank-sum test. Recursive partitioning analysis (RPA) and Bayesian Information Criteria (BIC) were used to identify the best dosimetric predictors for RT-attributed late severe DM

Results: 207 patients formed the cohort. The median time from RT end to MDASI-HN completion was 88 months. Median age was 57.8 years; 45% were former smokers. Most tumors (70%) originated from the oropharynx, and 66% were node positive. RT was the definitive modality in 97%; 47% had received concurrent and 35% induction chemotherapy. IMRT was utilized in 90%; median RT dose was 69.96 Gy. Mean DM score was 3.84 and 29% reported score of ≥ 6. On univariate analysis, higher Dmean to each ROI was associated with higher DM score (p≤0.05 for each). After adjusting for clinical factors, an association remained between DM score and Dmean of C-SMGs using multivariate analysis (p<0.01). Dmean to C-SMGs and C-PGs in patients with severe DM vs. those without were statistically higher (53 and 25 vs. 41 and 19 Gy, p=0.005 and 0.006, respectively), while a non-statistically significant higher Dmean to EOCM, ipsilateral SMG and PG were identified in the patients who reported severe DM vs. those that didn’t (44, 61 and 34 vs. 40, 58 and 33, respectively, p>0.05). RPA showed that the DVH-derived C-PG (V12Gy≥53%) and C-SMG (V58Gy≥35%) dosimetric parameters were associated with severe DM, and C-SMG V58≥35 showed the lowest (i.e., superior) BIC values (consistent with a 75-95% posterior probability of improved model performance for prediction of late severe DM compared to other dosimetric parameters).

Conclusion: Long-term patient reported severe DM was identified in approximately 30% of this cohort with the strongest correlation between severity and doses to contralateral major salivary glands. Systematically applying dosimetric constraints to major and minor salivary glands (specifically: ~V58 ≥ 35of C-SMG and ~V12≥53C-PG) could reduce the severity of patient-reported DM during survivorship

Author Disclosure: M. Kamal: None. D.I. Rosenthal: Advisory Board; BMS. R.P. Goepfert: None. A.S. Garden: None. K.A. Hutcheson: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research, NIH/National Cancer Institute (NCI) Small Grants Program for Cancer Research. S. Eraj: None. A. Dursteler: None. J. Aymard: None. J. Berends: None. S.J. Frank: Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Imaging. Chairman; American Brachytherapy Society. Director; C4 Imaging. Director-at-large; North America Skull Base Society. W.H. Morrison: Advisory Board; Regeneron. Stock; Merck, Baxter, Johnson and Johnson. Member; NCCN Nonmelanoma Skin and Merkel Cell Committees. A.S. Mohamed: Research Grant; National Institutes of Health (NIH)/National Institute for Dental and Craniofacial Research, National Institutes of Health (NIH). C.D. Fuller: Research Grant; National Institutes of Health, National Science Foundation, Elekta AB. Grant funding; Elekta AB. Honoraria; Nederlandse Organisatie voor Wetenschappelijk Onde. Consultant; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Travel Expenses; Elekta AB, Nederlandse Organisatie voor Wetenschappelijk Onde. Reviewer; Radiological Society of North America. Associate Editor; Radiographics. Data Management Task Force Committee Member; MR-LinAc Consortium. Member; National Cancer Institute. Task Group Member; American Association of Physicists in Medicine. G.B. Gunn: Associate Medical Director; MD Anderson Cancer Center - Proton Therapy.

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