A prospective study examining the onset and progression of acute toxicity and patient-reported side effects during altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer

Abstract

Introduction Acute grade 3 and 4 toxicity is commonly reported in trials examining altered fractionation radiotherapy (AFRT), due to its impact on treatment tolerance, the potential for consequential late effects, and mortality. Less well described is the mild-moderate acute toxicity and its impact on function. This study aims to examine acute toxicity and patient-reported side effects, and how they impact on function during AFRT. Study Design A prospective cohort design study. Materials and Methods Thirteen patients with T1-T3 oropharyngeal SCC were assessed weekly during, and at four weeks post-AFRT. Acute toxicity was graded using the CTCAE, and patients attended speech pathology/dietetic reviews where they reported functional barriers. Swallowing and weight measures were recorded. Results Most participants experienced peak grade 2 toxicity for all CTCAE components, except laryngeal edema. Grade 3 mucositis and dysphagia was noted in 31% and 23% respectively. Peak toxicity occurred in week 5 of treatment; however barriers to oral intake occurred from week 1. Modified diet with supplementation was required for 92% by week 3. Participants lost 5 kg during treatment. By four weeks post-treatment acute toxicity was resolving, with ongoing diet modification and weight loss. Conclusion Mild-moderate acute toxicity impacted on functional swallowing and weight from weeks 1-2, with increasing severity by week 3, before patients commenced their twice daily "concomitant boost" treatments. As acute toxicity resolved, the impact on oral intake and weight continued. Future studies should record toxicity and barriers to oral intake routinely until its resolution, rather than at arbitrary time points post-treatment.