Dysphagia-Optimized IMRT Shows Significance in Head and Neck Cancer

Christopher Nutting, MD, joint head of the Division of Radiotherapy and Imaging at The Institute of Cancer Research and consultant clinical oncologist at The Royal Marsden, discusses the results of a randomized phase 3 trial using dysphagia-optimized intensity modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT) in patients with head and neck cancer.

This study included 112 patients who were randomized 1:1 to receive either S-IMRT or Do-IMRT. The primary end point was the MD Anderson Dysphagia Inventory (MDADI), which was collected 12 months after patients completed treatment. Most of the patients were male, and the most common tumor location was the oropharynx. Among the patients participating, 90% had prior chemotherapy and radiation, which is standard protocol in this setting. A majority of patients were human papilloma virus-positive, which is a group with good long-term prognosis for carrying the burden of the treatment, according to Nutting.

Nutting says the first finding in the study was that the investigators were able to reduce the radiation dose to the muscles in the experimental arm, which is what the investigators were hoping for. The MDADI score at 12 months was about 70 points out of 100 in the group of patients receiving S-IMRT, which is expected in pretrial analyses. The Do-IMRT group had about 78 points for the MDADI score. This was statistically significant, with a P value of 0.016. A score difference of 5 to 10 points is considered to be a clinically relevant improvement in the MDADI score, he explains.

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