dc.contributor.author | Petkar, I | |
dc.contributor.author | Bhide, S | |
dc.contributor.author | Newbold, K | |
dc.contributor.author | Harrington, K | |
dc.contributor.author | Nutting, C | |
dc.date.accessioned | 2017-04-05T16:10:32Z | |
dc.date.issued | 2017-07-01 | |
dc.identifier.citation | Clinical oncology (Royal College of Radiologists (Great Britain)), 2017, 29 (7), pp. e110 - e118 | |
dc.identifier.issn | 0936-6555 | |
dc.identifier.uri | https://repository.icr.ac.uk/handle/internal/563 | |
dc.identifier.eissn | 1433-2981 | |
dc.identifier.doi | 10.1016/j.clon.2017.02.002 | |
dc.description.abstract | Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan. | |
dc.format | Print-Electronic | |
dc.format.extent | e110 - e118 | |
dc.language | eng | |
dc.language.iso | eng | |
dc.publisher | ELSEVIER SCIENCE LONDON | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0 | |
dc.subject | Humans | |
dc.subject | Pharyngeal Neoplasms | |
dc.subject | Deglutition Disorders | |
dc.subject | Aged | |
dc.subject | Middle Aged | |
dc.subject | Radiotherapy, Intensity-Modulated | |
dc.title | Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it? | |
dc.type | Journal Article | |
dcterms.dateAccepted | 2017-01-24 | |
rioxxterms.versionofrecord | 10.1016/j.clon.2017.02.002 | |
rioxxterms.licenseref.uri | https://creativecommons.org/licenses/by/4.0 | |
rioxxterms.licenseref.startdate | 2017-07 | |
rioxxterms.type | Journal Article/Review | |
dc.relation.isPartOf | Clinical oncology (Royal College of Radiologists (Great Britain)) | |
pubs.issue | 7 | |
pubs.notes | No embargo | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Cancer Biology | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Cancer Biology/Targeted Therapy | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Clinical Academic Radiotherapy (Huddart) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Targeted Therapy | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Cancer Biology | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Cancer Biology/Targeted Therapy | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Clinical Academic Radiotherapy (Huddart) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Targeted Therapy | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.publication-status | Published | |
pubs.volume | 29 | |
pubs.embargo.terms | No embargo | |
icr.researchteam | Clinical Academic Radiotherapy (Huddart) | |
icr.researchteam | Targeted Therapy | |
dc.contributor.icrauthor | Petkar, Imran | |
dc.contributor.icrauthor | Harrington, Kevin | |