It is not just IMRT: XXXX related @entity957 is associated with better swallowing outcomes after definitive chemoradiotherapy.

@entity1 @entity137 @entity957 @entity1082 @entity734
OBJECTIVES: Long term swallowing dysfunction in @entity1 with @entity957 ( @entity957 ) treated with concurrent chemoradiation (CRT) is declining. While the use of intensity modulated radiotherapy (IMRT) is commonly believed to be a potential cause, we hypothesize that the increasing incidence of @entity1082 ) related disease may also favorably impact this outcome. MATERIALS AND METHODS: We reviewed 130 HPV+ and 17 HPV- @entity1 with stage III-IV @entity957 treated exclusively with conventional 3-field radiotherapy with chemotherapy between 2002 and 2010. The rates of normal diet, limited diet (significant restrictions in the types of foods eaten, and/or requiring nutritional supplementation for weight maintenance) and @entity734 ( @entity734 ) were compared between HPV+ and HPV- @entity1 . Cox proportional hazards modeling were used to perform univariate analysis (UVA) to examine predictors of a combined endpoint of dietary limitation, which included limited diet and/or @entity734 . These outcomes were also compared to our previously reported cohort of @entity957 @entity1 treated between 1989 and 2002 to assess changes in @entity137 over time given the changing disease epidemiology, in the setting of identical treatment regimens. RESULTS: With a median follow-up of 55months, HPV+ @entity1 more frequently had resumed a normal diet (87% vs. 65%) at last follow up and had lower rates of limited diet (9% vs. 18%) and @entity734 (4% vs. 18%) compared to HPV- @entity1 (p=0.02). HPV status was the only significant predictor of reduced swallowing dysfunction on UVA (HR 0.19; p=0.008). When compared to our 1989-2002 cohort, @entity1 treated between 2002 and 2010 had less @entity734 (7.5% vs. 34%, p<0.001) and dietary limitations (26% vs.46%, p<0.001) at 6months post treatment. CONCLUSIONS: HPV+ @entity1 with @entity957 have reduced late swallowing dysfunction after chemoradiation compared to HPV- @entity1 . The changing epidemiology of @entity957 may play a role in @entity137 reduction in these @entity1 , independent of the increasing use of IMRT.
