Optimised IMRT can help reduce swallowing difficulties for head and neck cancer patients

An 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 adverse life-long side effects in head and neck cancer patients following treatment.

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 virtual conference.

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

Half of newly-diagnosed patients with oropharyngeal and hypopharyngeal cancers recruited to the trial received standard IMRT and the other half received IMRT optimised to reduce the dose to the structures related to swallowing and breathing.

Patients with head and neck cancer have a 90 per cent 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 per cent of patients given optimised IMRT reported their swallowing was as good as ever in comparison to just 15 per cent for the standard treatment.

At the Royal Marsden, operational lead Mandy Humphreys, pre-treatment superintendent radiographer Craig Lacey and operational superintendent radiotherapist Sharon Cubitt are working on the trial. They explained that, due to the prevalence of HPV as a cause for cancer in the head and neck, patients are being diagnosed at a younger age. With radiotherapy or chemo/radiotherapy being the primary treatment, the cancer may be cured but the long-term side effects such as dysphagia disrupt the patient’s daily experience and lead to feelings of physical, emotional and social loss.

Primarily these side effects are weight loss, inability to eat foods previously enjoyed, and the need to eat alone because eating takes so much time.

“As therapeutic radiographers we have been at the forefront of delivering these advanced radiotherapy techniques and have seen the role this has played in improving long-term survivorship for head and neck patients. We triage all patients daily and provide supportive and ongoing care during their radiotherapy journey with us. We have experienced first-hand other successful organ-sparing trials such as PARSPORT and COSTAR, and have now been able to see the positive outcomes of the DARS trial,” they said.

“For us this underpins the importance of continuing to develop our radiotherapy planning and delivery techniques and how effective this can be for patients living with and beyond cancer. We can see the impact these side effects can have on patients and their carers but also the significance of these positive trial outcomes.”

Picture: The Royal Marsden is collaborating with The Institute of Cancer Research on the DARS trial.

Published on page 14 of the July 2020 issue of RAD Magazine.