Can the risk of dysphagia in head and neck radiation therapy be predicted by an automated transit fluence monitoring process during treatment? A first comparative study of patient reported quality of life and the fluence-based decision support metric Journal Article

   

Authors:	Lim, S. B.; Lee, N.; Zakeri, K.; Greer, P.; Fuangrod, T.; Coffman, F.; Cerviño, L.; Lovelock, D. M.
Article Title:	Can the risk of dysphagia in head and neck radiation therapy be predicted by an automated transit fluence monitoring process during treatment? A first comparative study of patient reported quality of life and the fluence-based decision support metric
Abstract:	PURPOSE/OBJECTIVE(S): The additional personnel and imaging procedures required for Adaptive Radiation Therapy (ART) pose a challenge for a broad implementation. We hypothesize that a change in transit fluence during the treatment course is correlated with the change of quality of life and thus can be used as a replanning trigger. MATERIALS/METHODS: Twenty-one head and neck cancer (HNC) patients filled out an MD Anderson Dysphagia Inventory (MDADI) questionnaire, before-and-after the radiotherapy treatment course. The transit fluence was measured by the Watchdog (WD) in-vivo portal dosimetry system. The patients were monitored with daily WD and weekly CBCTs. The region of interest (ROI) of each patient was defined as the outer contour of the patient between approximate spine levels C1 to C4, essentially the neck and mandible inside the beam's eye view. The nth day integrated transit fluence change, Δφn, and the volume change, ΔVROI, of the ROI of each patient was calculated from the corresponding WD and CBCT measurements. The correlation between MDADI scores and age, gender, planning mean dose to salivary glands <Dsg>, weight change ΔW, ΔVROI, and Δφn, were analyzed using the ranked-Pearson correlation. RESULTS: No statistically significant correlation was found for age, gender and ΔW. <Dsg> was found to have clinically important correlation with functional MDADI (ρ = -0.39, P = 0.081). ΔVROI was found to have statistically significant correlation of 0.44, 0.47 and 0.44 with global, physical and functional MDADI (P-value < 0.05). Δφn was found to have statistically significant ranked-correlation (-0.46, -0.46 and -0.45) with physical, functional and total MDADI (P-value < 0.05). CONCLUSION: A transit fluence based decision support metric (DSM) is statistically correlated with the dysphagia risk. It can not only be used as an early signal in assisting clinicians in the ART patient selection for replanning, but also lowers the resource barrier of ART implementation.
Keywords:	dysphagia; head and neck cancer; xerostomia; in-vivo dosimetry; adaptive radiation therapy; decision support informetric
Journal Title:	Technology in Cancer Research & Treatment
Volume:	20
ISSN:	1533-0346
Publisher:	Sage Publications, Inc.
Date Published:	2021-06-30
Language:	English
DOI:	10.1177/15330338211027906
PUBMED:	34190006
PROVIDER:	scopus
PMCID:	PMC8252347
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85110086014&doi=10.1177%2f15330338211027906&partnerID=40&md5=2e5ab782c119a5f29100f2938842cc62
Notes:	Article -- Export Date: 2 August 2021 -- Source: Scopus

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