A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer

Maja Bendtsen Sharma; Kenneth Jensen; Steen Fiil Urbak; Mikkel Funding; Jørgen Johansen; Dorte Bechtold; Ali Amidi; Simon Fristed Eskildsen; Jens Otto Lunde Jørgensen; Cai Grau

doi:10.1016/j.radonc.2020.07.029

A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer

Maja Bendtsen Sharma, Kenneth Jensen, Steen Fiil Urbak, Mikkel Funding, Jørgen Johansen, Dorte Bechtold, Ali Amidi, Simon Fristed Eskildsen, Jens Otto Lunde Jørgensen, Cai Grau

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.

METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.

RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.

CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.

Originalsprog	Engelsk
Tidsskrift	Radiotherapy & Oncology
Vol/bind	151
Sider (fra-til)	58-65
Antal sider	8
ISSN	0167-8140
DOI	https://doi.org/10.1016/j.radonc.2020.07.029
Status	Udgivet - 2020

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title = "A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer",

abstract = "PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.",

keywords = "Hypopituitarism, Intensity modulated radiotherapy, Late toxicity, Ocular toxicity, Sinonasal cancer",

author = "Sharma, {Maja Bendtsen} and Kenneth Jensen and Urbak, {Steen Fiil} and Mikkel Funding and J{\o}rgen Johansen and Dorte Bechtold and Ali Amidi and Eskildsen, {Simon Fristed} and J{\o}rgensen, {Jens Otto Lunde} and Cai Grau",

note = "Copyright {\textcopyright} 2020. Published by Elsevier B.V.",

year = "2020",

doi = "10.1016/j.radonc.2020.07.029",

language = "English",

volume = "151",

pages = "58--65",

journal = "Radiotherapy & Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd.",

}

TY - JOUR

T1 - A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer

AU - Sharma, Maja Bendtsen

AU - Jensen, Kenneth

AU - Urbak, Steen Fiil

AU - Funding, Mikkel

AU - Johansen, Jørgen

AU - Bechtold, Dorte

AU - Amidi, Ali

AU - Eskildsen, Simon Fristed

AU - Jørgensen, Jens Otto Lunde

AU - Grau, Cai

PY - 2020

Y1 - 2020

N2 - PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.

AB - PURPOSE: To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations.METHODS: Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life- (QoL) and dose-response analyses.RESULTS: Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19 %) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p=0.01; grade 3 OR 1.14, p=0.02) and dose constraint violations (grade 2, OR=21, p<0.01; grade 3, OR=41, p<0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63 %) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR=3.32, p=0.03). Three patients (11 %) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63 %). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56 %) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11 %) had radiation-related impaired function in all examined OARs.CONCLUSION: Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.

KW - Hypopituitarism

KW - Intensity modulated radiotherapy

KW - Late toxicity

KW - Ocular toxicity

KW - Sinonasal cancer

UR - http://www.scopus.com/inward/record.url?scp=85088654677&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2020.07.029

DO - 10.1016/j.radonc.2020.07.029

M3 - Journal article

C2 - 32697945

SN - 0167-8140

VL - 151

SP - 58

EP - 65

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

ER -

A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer

Abstract

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