Global assessment of swallow function (GASF) following VMAT radiotherapy for head and neck squamous cell carcinoma

Kate Toft; Kirsty McLachlan; Mark Winton; Karen Mactier; Nadine Hare; Claire Nugent; Lucie Wincott; Devraj Srinivasan; Joanna Mackenzie; Bill Nailon; David Noble

doi:10.1016/j.tipsro.2024.100272

Global assessment of swallow function (GASF) following VMAT radiotherapy for head and neck squamous cell carcinoma

Tech Innov Patient Support Radiat Oncol. 2024 Aug 30:32:100272. doi: 10.1016/j.tipsro.2024.100272. eCollection 2024 Dec.

Authors

Kate Toft^{1

2}, Kirsty McLachlan¹, Mark Winton¹, Karen Mactier^{1

3}, Nadine Hare¹, Claire Nugent¹, Lucie Wincott¹, Devraj Srinivasan¹, Joanna Mackenzie¹, Bill Nailon^{1

4

5

6}, David Noble^{1

6}

Affiliations

¹ Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.
² Department of Speech and Hearing Science, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK.
³ School of Cancer Sciences, College of Medicine, Veterinary Medicine and Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
⁴ The Institute for Imaging, Data and Communications (IDCOM), School of Engineering, The University of Edinburgh, Edinburgh EH9 3BF, UK.
⁵ The Department of Biomedical Engineering, Fulton Building, University of Dundee, Dundee DD1 4HN, UK.
⁶ Edinburgh Cancer Research Centre, The Institute of Genetics and Cancer, Crewe Road South, University of Edinburgh, Edinburgh EH4 2XU, UK.

Abstract

Aim: This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy.

Materials and methods: All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 - 2021 were eligible for inclusion.Patients were treated with VMAT radiotherapy according to institutional and national protocols.Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO).

Results: One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment.Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients' WST capacity improved by the minimal clinically important difference of > 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy.

Conclusions: This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapyexperience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.

Keywords: Dysphagia; Head and neck cancer; Outcomes; Radiotherapy.