Patient-Reported Outcomes After Swallowing (SWOARs)-Sparing IMRT in Head and Neck Cancers: Primary Results from a Prospective Study Endorsed by the Head and Neck Study Group (HNSG) of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

Objectives To prospectively investigate changes in M.D. Anderson Dysphagia Inventory (MDADI) scores in patients affected by naso- and oropharynx cancer after definitive radiochemotherapy (ChemoRT) using swallowing organs at risk (SWOARs)-sparing IMRT. Methods MDADI questionnaires were collected at baseline and at 6 and 12 months after treatment. MDADI scores were categorized as follows: >= 80 optimal, 80-60 adequate, < 60 poor deglutition-related quality of life (QoL) group, and dichotomized as optimal vs adequate/poor for the analysis. A mean MDADI composite (MDADI-C) change of 10 points was considered as minimal clinically important difference (MCID). Results Sixty-three patients were enrolled of which 47 were considered for the analysis. At baseline, 26 (55%) were optimal and 21 (45%) were adequate/poor. The mean baseline MDADI-C score was 93.6 dropping to 81 at 6 months (p = 0.013) and slightly rising to 85.5 at 12 months (p = 0.321) for the optimal group. Indeed, the mean baseline MDADI-C score was 64.3 rising to 77.5 at 6 months (p = 0.006) and stabilizing at 76 at 12 months (p = 0.999) for the adequate/poor group. A statistically significant but not clinically relevant worsening of the MDADI-C score was reported for the optimal group, whereas both a statistically significant and clinically meaningful improvement of the MDADI-C score were reported for the adequate/poor group from before to post-treatment. Conclusion Our results suggest a doubly clinical benefit of dose optimization to SWOARs to minimize the RT sequalae in patients with a baseline optimal deglutition-related QoL and to recover from cancer dysphagia in those with a baseline adequate/poor deglutition-related QoL.

Automated summary

This study aimed to investigate changes in M.D. Anderson Dysphagia Inventory (MDADI) scores in patients with naso- and oropharynx cancer after radiochemotherapy using IMRT with sparing of swallowing organs at risk (SWOARs). The results showed a slight decline in MDADI scores after treatment in the optimal group, and a significant and clinically meaningful improvement in the adequate/poor group. Therefore, dose optimization to SWOARs can minimize treatment-related symptoms in patients with optimal deglutition-related quality of life and help those with adequate/poor deglutition-related quality of life recover from cancer dysphagia.