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ASCO 2020: New optimised precision radiotherapy can reduce swallowing difficulties for head and neck cancer patients

Radiotherapy IMRT (photo: Jan Chlebik/the ICR)

Image: Radiotherapy IMRT. Credit: Jan Chlebik, The ICR

A new optimised intensity-modulated radiation therapy (IMRT) pioneered at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, has been shown to spare head and neck cancer patients’ adverse life-long side effects post treatment.

The initial results from the Dysphagia-Aspiration Related Structures (DARS) trial, funded by Cancer Research UK and the National Institute for Health Research, were presented at the American Society for Clinical Oncology (ASCO) virtual conference this week.

The randomised study found patients with head and neck cancer experienced less adverse side effects with the new precision radiotherapy technique optimised to reduce the risk of swallowing difficulties, known as dysphagia.

Half of newly diagnosed patients with oropharyngeal and hypopharyngeal cancers (tumours of the throat) recruited to the trial received standard IMRT radiotherapy and the other half received IMRT optimised to reduce the radiation dose to the structures related to swallowing and breathing. The trial recruited 112 patients across 23 UK cancer centres.

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Difficulties eating and drinking

Patients with head and neck cancer have a 90 percent survival rate but can be left with life changing side effects including swallowing problems, making it difficult to eat and drink. The self-reported measure of swallowing ability as perceived by patients themselves was better in the optimised IMRT group.

Twelve months after treatment, 40 percent of patients given the optimised form of precision radiotherapy reported their swallowing was as good as ever in comparison to just 15 percent on the standard treatment.

The DARS trial was managed by the ICR Clinical Trials and Statistics Unit and supported by strong collaborations between participating hospitals and a multidisciplinary team of doctors, speech and language therapists (SLT), radiographers, research nurses and physicists.

Professor Chris Nutting, Head of the Head and Neck Unit at The Royal Marsden and Joint Head of the Division of Radiotherapy and Imaging at the ICR, said:

“The optimised IMRT treatment will be a game changer for treating head and neck patients in the future. The DARS trial has proved the new technique can spare the swallowing muscles for patients without lessening the success of their treatment.”

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Profound impact on quality of life

Dr Justin Roe, Consultant SLT and Joint Head of the Department of Speech, Voice and Swallowing at The Royal Marsden, said:

“Despite improvements in radiotherapy treatments in recent years, people can be left with varying degrees of swallowing difficulty. In some cases, this can have a profound impact on quality of life with people unable to eat and drink safely and comfortably. This has a particular impact during mealtimes and in social situations. It can also have a significant impact on hydration, nutrition and in the most severe cases, can lead to pneumonia. It is very encouraging to see how much improvement there has been in people who received the dysphagia-optimised IMRT.”

Martin Ledwick, Cancer Research UK’s head nurse, said:

“It’s difficult for many of us to imagine not being able to swallow, but this is often the devastating reality for head and neck cancer patients post treatment. The findings of this trial are very exciting and offer hope that this new radiotherapy technique has the potential to make a big improvement to quality of life for these patients after cancer.”

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radiotherapy ASCO head and neck cancer CTSU IMRT Chris Nutting
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