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A Magnetic Resonance Imaging-based approach to quantify radiation-induced normal tissue injuries applied to trismus in head and neck cancer.

ABSTRACT: BACKGROUND AND PURPOSE:In this study we investigated the ability of textures from T1-weighted MRI scans post-contrast (T1wpost) to identify the critical muscle(s) for radiation-induced trismus. MATERIALS AND METHODS:The study included ten cases (Trismus: ?Grade 1), and ten age-sex-tumor-location-and-stage-matched controls treated with intensity-modulated radiotherapy to 70Gy@2.12Gy in 2005-2009. Trismus status and T1wPost were conducted within one year post-radiotherapy. For the masseter, lateral and medial pterygoids, and temporalis (M/LP/MP/T), 24 textures were extracted (Grey Level Co-Occurrence (GLCM), Histogram, and Shape). Univariate logistic regression with Bootstrapping (1000 populations) was applied to compare the muscle mean dose (Dmean) and textures between cases and controls (ipsilateral muscles); candidate predictors were suggested by an average p?0.20 across all Bootstrap populations. RESULTS:Dmean to M/LP/MP (p=0.03/0.14/0.09), one MP/T (p=0.12/0.17), and three M (p=0.14-0.19) textures were candidate predictors. Three of these textures were GLCM- and two Histogram textures with the former being generally higher and the latter lower for cases compared to controls. The Dmean to M and MP, and Haralick Correlation (GLCM) of MP presented with the best discriminative ability (area under the receiver-operating characteristic curve: 0.85, 0.77, and 0.78), and the correlation between Dmean and this texture was weak (Spearman's rank correlation coefficient: 0.26-0.27). CONCLUSIONS:Our exploratory study points towards an interplay between the dose to the masseter, and the medial pterygoid together with the local relationship between the mean MRI intensity relative to its variance of the medial pterygoid for radiation-induced trismus. This opens up for exploration of this interplay within the radiation-induced trismus etiology in the larger multi-institutional setting.

SUBMITTER: Thor M

PROVIDER: S-EPMC5648027 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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A Magnetic Resonance Imaging-based approach to quantify radiation-induced normal tissue injuries applied to trismus in head and neck cancer.

Thor Maria M Tyagi Neelam N Hatzoglou Vaios V Apte Aditya A Saleh Ziad Z Riaz Nadeem N Lee Nancy Y NY Deasy Joseph O JO

Physics and imaging in radiation oncology 20170101

<h4>Background and purpose</h4>In this study we investigated the ability of textures from T1-weighted MRI scans post-contrast (T1w<sub>post</sub>) to identify the critical muscle(s) for radiation-induced trismus.<h4>Materials and methods</h4>The study included ten cases (Trismus: ≥Grade 1), and ten age-sex-tumor-location-and-stage-matched controls treated with intensity-modulated radiotherapy to 70Gy@2.12Gy in 2005-2009. Trismus status and T1w<sub>Post</sub> were conducted within one year post-r ...[more]

PMID: 29057333

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Project description:ImportanceTrismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication.ObjectiveTo assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus.Design, setting, and participantsThis retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were referred for treatment of radiation-associated trismus.InterventionIntraoral MT (including or excluding external head and neck) targeting the muscles of mastication.Main outcomes and measuresMaximum interincisal opening (MIO) before and after the initial MT session compared with serial MT sessions. Covariates were examined to determine the association with response to MT for trismus.ResultsA total of 49 survivors of HNC (13 women [27%]; 24 [49%] 64 years or younger; 25 [51%] 65 years or older; mean [range] of 6.6 [0-33] years postradiotherapy were included, 9 [18.4%] of whom underwent a single MT session; 40 [81.6%] who underwent multiple sessions [mean, 6; median (range), 3 (2-48)]). The MIO improved after a single session by a mean (SD) of 4.1 (1.9) mm (0.45 effect size) and after serial MT sessions by a mean (SD) of 6.4 (4.8) mm with an effect size of 0.7. No covariates were found to be clinically meaningfully associated with MIO improvement following MT.Conclusions and relevanceThe findings of this case series study suggest that MT improved MIO with a medium to large effect size in survivors of HNC with radiation-associated trismus. The results suggest that the largest increase in oral opening was achieved after the initial treatment and although gains were more modest, oral opening continued to improve with serial treatment. Covariates were not associated with MT response, suggesting that patients with clinical features often considered treatment refractory (eg, advanced disease, multiple lines of oncology treatment, ≥5 years posttreatment) may benefit from treatment with MT. Manual therapy may be a beneficial frontline or adjuvant treatment when combined with traditional stretching therapy. A clinically meaningful increase in oral opening has the potential to improve swallow function, speech, pain, and quality of life.

Dataset Information

A Magnetic Resonance Imaging-based approach to quantify radiation-induced normal tissue injuries applied to trismus in head and neck cancer.

Publications

A Magnetic Resonance Imaging-based approach to quantify radiation-induced normal tissue injuries applied to trismus in head and neck cancer.

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