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PQA 10 - PQA 10 Head & Neck Cancer and Health Services Research/Global Oncology Poster Q&A

3619 - Determinants of Chemosensory Dysfunction after Treatment for Nasopharyngeal Carcinoma: A Multi-Institutional Prospective Cohort Study

Wednesday, October 2, 2024
10:30 AM – 11:45 AM ET
Location: Hall C

Screen: 7

    Presenter(s)

  • Annie Chan, MD

    Massachusetts General Hospital
    Boston, MA, United States

J. Slater1, F. M. Fang2, S. I. Goldberg3, and A. W. Chan1; 1Department of Radiation Oncology, Massachusetts General Hospital- Harvard Medical School, Boston, MA, 2Proton and radiation therapy center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA

Determinants of Chemosensory Dysfunction After Treatment for Nasopharyngeal Carcinoma: A Multi-Institutional Prospective Cohort Study

Purpose/Objective(s): Though taste and smell dysfunction are very common after definitive chemoradiation for nasopharyngeal carcinoma (NPC), its etiology, however, is unclear. The purpose of this study was to identify treatment factors associated with patient-reported chemosensory dysfunction in a prospective multi-institutional prospective cohort.

Materials/

Methods: Ninety-three patients with biopsy-confirmed stage I-IVB NPC were enrolled; 24 patients were treated with proton therapy and 69 patients with IMRT. Patients were treated with concurrent proton with cisplatin and adjuvant cisplatin/5-fluorouracil or concurrent IMRT with cisplatin. ChemoSensory Questionnaire (CSQ) at 12 and 24 months was used to define dosimetric determinants using mixed logistic regression analysis. EORTC H&N35 at 12 and 24 months was used to compare chemosensory dysfunction after IMRT and proton using a generalized linear mixed model. Cox proportional-hazards model was used for multivariate analyses.


Results: When compared to IMRT, proton treatment resulted in 46% reduction in oral cavity mean dose (p<0.0001). In multivariate analysis after adjusted for T-stage and use of adjuvant chemotherapy, IMRT was independently associated with worse taste (p = 0.015, coefficient of regression 29.76, 95% CI 5.86 - 53.65) and smell outcomes (p = 0.024, coefficient of regression 30.55, 95% CI 4.11 - 56.99) when compared to proton therapy. Anterior oral tongue mean dose (p=0.046), posterior oral tongue mean dose (p=0.043), parotid mean dose (p=0.007) and use of adjuvant chemotherapy (p=0.014) were associated with moderate-severe taste dysfunction. Nasal cavity-ethmoid sinus mucosa mean dose (p=0.050), sphenoid sinus mucosa mean dose (p=0.012), olfactory bulb mean dose (p=0.032), and use of adjuvant chemotherapy (p=0.028) were associated with moderate-severe smell dysfunction.


Conclusion: Patients treated with proton therapy report significantly less chemosensory dysfunction compared to IMRT. These newly defined dosimetric determinants can be incorporated into treatment planning to minimize chemosensory dysfunction in NPC survivors. Randomized trials are needed to confirm our findings.