A Prospective Study to Assess Radiation-Induced Dysphagia in Head and Neck Cancer Patients Treated with Dysphagia Optimized IMRT/VMAT Technique

Background and objectives: Dysphagia is a common side effect of radiation therapy for head and neck cancers, significantly impacting patients’ physical, social, and emotional well-being. Validating efficient dysphagia-optimized radiotherapy techniques is crucial for improving health-related quality of life, a key determinant of curative management strategies. This study aims to analyze the clinical and functional outcomes following radical radiation in head and neck cancer patients using dysphagia-optimized radiation techniques. Methods: This single-institution, prospective observational study assesses swallowing function clinically and using objective methods in patients with head and neck cancer treated with dysphagia-optimized IMRT/VMAT. The Dysphagia Aspiration-Related Structures (DARS) were delineated separately, with dose limits set by the DAHANCA guidelines. Clinical and objective assessments were conducted using ENT evaluation, clinical swallow study, UW QOL, and PSS HN questionnaires at 3- and 6-month intervals following radiation. Results: Thirty-nine patients were enrolled, receiving either definitive or adjuvant radiation treatment with bilateral nodal irradiation. Significant differences in dysphagia were observed at 6 months post-radiation (p < 0.01). Grade 1 to 2 (CTCAE V 5.0) dysphagia was noted in most patients at 3 months post-RT, improving markedly by 6 months post-RT. All patients were disease-free at the 6-month follow-up, demonstrating effective local control and improved QOL with dysphagia-optimized IMRT/VMAT. Conclusion: Using dysphagia-optimized IMRT/VMAT reduces the dose to DARS structures, enhancing the quality of life for patients undergoing definitive or adjuvant radiation therapy for head and neck malignancies without compromising local tumor control.