The influence of radiation dose on taste impairment in a prospective observational study cohort of oropharyngeal cancer patients

Abstract

Background

To analyze the influence of radiation dose on late radiation-associated taste impairment in oropharyngeal cancer (OPC) patients treated with intensity-modulated radiotherapy (IMRT) using the taste bud bearing tongue mucosa as organ at risk.

Material and methods

This study is part of an ongoing, prospective observational study. Cancer-free OPC survivors with at least 24 months from IMRT were included in this analysis. Scores for taste impairment and dry mouth were extracted from the MD Anderson Symptom Inventory Head and Neck module (MDASI-HN) with scores of ≥5 considered as moderate-to-severe symptoms. The mean dose, minimum and maximum dose to the taste bud bearing tongue mucosa, the ipsi- and contralateral parotid and submandibular glands were extracted and analyzed for correlation with moderate-to-severe taste impairment.

Results

One hundred sixteen T1–4 OPC patients were included (81% males, median age: 55). The primary tumor was in the tonsil in 92 cases (79%) and in the base of tongue in 21 cases (18%). Patients were treated with 64.2–72.0 Gy; 37 patients (32%) received concurrent chemotherapy and 22 (19%) concurrent targeted therapy. After a median of 58 months from RT (IQR: 43–68) 38 patients (33%) suffered from moderate-to-severe long-term radiation-associated taste impairment. No dose volume parameter of the taste bud bearing tongue mucosa and the salivary glands was significantly associated with moderate-to-severe taste impairment for the whole patient cohort. For patients without concurrent chemotherapy, the minimum and mean dose to the ipsilateral parotid gland, and the maximum dose to the submandibular gland was significantly associated with late taste impairment (all p < 0.05). A significant correlation was found between taste impairment and dry mouth (p < 0.001).

Conclusion

The dose to the ipsilateral parotid gland seems to play an important role in the development of late taste impairment. The influence of dose to the taste bud bearing tongue mucosa remains unclear and needs further investigation.

Keywords:

• Head and neck neoplasms
• oropharyngeal cancer
• taste
• radiotherapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

S. Stieb received funding from the Swiss Cancer League [BIL KLS-4300-08-2017]. G.M. Engeseth is funded by the Trond Mohn foundation. S.J. Frank has received grants from C4 Imaging, Eli Lilly, Elekta, and Hitachi. G.B. Gunn is supported by a philanthropic donation made by the Family of Paul W. Beach. C.D. Fuller received funding from the National Institute for Dental and Craniofacial Research Award [1R01DE025248-01/R56DE025248] and Academic-Industrial Partnership Award [R01 DE028290], the National Science Foundation (NSF), Division of Mathematical Sciences, Joint NIH/NSF Initiative on Quantitative Approaches to Biomedical Big Data (QuBBD) Grant [NSF 1557679], the NIH Big Data to Knowledge (BD2K) Program of the National Cancer Institute (NCI) Early Stage Development of Technologies in Biomedical Computing, Informatics, and Big Data Science Award [1R01CA214825], the NCI Early Phase Clinical Trials in Imaging and Image-Guided Interventions Program [1R01CA218148], the NIH/NCI Cancer Center Support Grant (CCSG) Pilot Research Program Award from the UT MD Anderson CCSG Radiation Oncology and Cancer Imaging Program [P30CA016672], the NIH/NCI Head and Neck Specialized Programs of Research Excellence (SPORE) Developmental Research Program Award [P50 CA097007] and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) Research Education Program [R25EB025787]. He has received direct industry grant support from Elekta.