Swallowing Outcomes Post Volumetric Modulated Arc Therapy for Head and Neck Cancer Patients Using MD Anderson Dysphagia Inventory: An Institutional Experience

Background: MD Anderson dysphagia inventory (MDADI) is a dysphagia-specific quality of life (QOL) questionnaire for patients with head and neck (H&N) cancer. Objectives: This study aimed at ascertaining the impact of dysphagia on the QOL of patients undergoing radiation therapy for H&N cancer with curative intent. Methods: This prospective observational study was conducted at a tertiary care hospital in India. Patients with H&N cancer meeting the selection criteria were enrolled in this study. The patients completed the MDADI questionnaire administered to them at the treatment completion and 3 to 6 months after the treatment. The chi-square test, Independent-samples t-test, and Spearman correlation coefficients were used for analysis. Results: After the treatment, the total MDADI score was significantly related to the constrictor mean dose (P = 0.035) and larynx mean dose (P = 0.050). This association was maintained 3 months after the treatment by the constrictors and larynx mean dose (P < 0.05). Keeping the dose constraints for constrictors < 50 Grays (Gy) and larynx < 45 Gy resulted in a better QOL. The mean doses to the cervical esophagus did not statistically correlate with the questionnaire scores. At 6 months after the treatment, a correlation was seen only with the larynx mean doses. Spearman's rank analysis was significantly correlated to the total as well as individual MDADI scores. Conclusions: MDADI scores provided significant insights into the dysphagia-related QOL for patients with H&N cancer. Modern techniques like volumetric modulated arc therapy (VMAT) are translated into an improved QOL for patients and justify their use. Furthermore, parameters like V30/V40 would have been even more valuable and should be undertaken in future studies.