People treated with radiotherapy for head and neck cancer experience several acute and chronic effects of this treatment, of which fibrosis is perhaps the most common. Fibrosis occurs as a wound healing response and leads to scarring and reduced range of motion of muscles. Radiation fibrosis is usually chronic and progressive and a significant contributor to radiation-induced dysphagia. It has not previously been possible to accurately quantify radiation fibrosis. The authors of this paper describe their exploratory approach using secondary analysis of magnetic resonance imaging (MRI) data from previous studies at their institution. The aim was to determine whether clinical MRI could reliably measure fibrosis of the pharyngeal musculature after radiotherapy. They also measured change over time of fibrosis volumes and swallow physiology, and the association of fibrosis over time with swallow impairment after radiotherapy. They obtained data from 42 adults who had at least two MRIs and videofluoroscopy studies from baseline (pre-radiotherapy) up to 12 months post radiotherapy. Using well-established reliability methods, they report that fibrosis volume increased from three months to 12 months by a mean change of 1.28mL (SD=5.21, p=0.006). Pharyngeal impairment also increased from baseline to 12 months, with a mean score change of 3.05 (SD=3.02, p=0.003). There was a moderate correlation between fibrosis volume and pharyngeal impairment at three months (0.49, p=0.004) and 12 months (0.59, p=0.005). The authors conclude that MRI could offer a reliable and pragmatic way of measuring fibrosis and concomitant dysphagia, and could be a useful way to compare early to late evolution of fibrosis. This could be the first step toward mitigating some of the effects of fibrosis on swallowing.
Measuring radiation fibrosis in patients with head and neck cancer
Reviewed by Roganie Govender
The Quantification of Radiation Fibrosis Using Clinically Indicated Magnetic Resonance Imaging for Head and Neck Cancer Patients.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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