Impact of GTV-CTV margin and other predictors on radiation-induced dysphagia in head and neck cancer patients from DAHANCA group

Authors

  • Sarah Wordenskjold Stougaard Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark https://orcid.org/0000-0002-2654-5469
  • Ruta Zukauskaite Department of Oncology, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0003-0915-6880
  • Richard Röttger Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
  • Ebbe Laugaard Lorenzen Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0003-1895-733X
  • Maximilian Lukas Konrad Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  • Simon Long Krogh Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark https://orcid.org/0009-0007-7511-989X
  • Camilla Panduro Nielsen Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark https://orcid.org/0000-0001-7547-5455
  • Jeanette Frieda Aviaya Sommer Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
  • Jørgen Johansen Department of Oncology, Odense University Hospital, Odense, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0003-3911-3929
  • Jesper Grau Eriksen Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0002-1145-6033
  • Camilla Kjaer Lonkvist Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark https://orcid.org/0009-0003-9692-0839
  • Jeppe Friborg Department of Clinical Oncology, Rigshospitalet, Copenhagen, Denmark https://orcid.org/0000-0001-5423-0627
  • Carsten Brink Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark https://orcid.org/0000-0003-3906-1962
  • Christian Rønn Hansen Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark https://orcid.org/0000-0001-5716-6069

DOI:

https://doi.org/10.2340/1651-226X.2025.44021

Keywords:

Radiotherapy, side effects, Head and neck cancer, guidelines, Prediction model

Abstract

Background and purpose: This multicentre, retrospective study aimed to develop a predictive model for radiation-induced dysphagia in head and neck cancer patients, focusing on the role of gross tumour volume (GTV) to high dose CTV (CTV1) margin size and dose-related factors. Unlike previous studies focused on peak or single time-point dysphagia, this study modelled symptom trajectories using repeated follow-up data for a more complete picture.

Patient/material and methods: Between 2010 and 2015, 1,948 patients with pharyngeal or laryngeal squamous cell carcinoma received definitive intensity-modulated radiotherapy (IMRT) at three Danish centres. Data included physician-rated dysphagia (grade 0–4), tumour and treatment characteristics, and AI-based segmentations of organs at risk (OARs). Predictors included GTV-CTV1 margin size, mean doses to the oral cavity and pharyngeal constrictor muscles (PCM), GTV volume, chemotherapy, tumour site, fractionation, nimorazole, sex, smoking status, baseline dysphagia, and age. A logistic ordinal mixed-effects model was fitted with patient ID as random effect. Data were split into training (70%) and test (30%) sets. Model performance was assessed using calibration plots and area under the curve (AUC).

Results: After excluding incomplete cases, 1,685 patients (7,829 visits) were analysed. GTV-CTV1 margin size was not significantly associated with dysphagia, although larger margins correlated with higher OAR doses. Higher doses to the lower PCM (odds ratio [OR] = 1.30 per 5 Gy) and oral cavity (OR = 1.32 per 5 Gy) increased risk. The model demonstrated good calibration and robust discrimination (AUC = 0.77–0.84).

Interpretation: Radiation dose to the oral cavity and lower PCM were the strongest modifiable predictors of dysphagia risk. Margin size was not independently associated, possibly due to confounding by clinical judgement.

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Published

2025-09-18

How to Cite

Wordenskjold Stougaard, S., Zukauskaite , R., Röttger , R., Laugaard Lorenzen , E., Lukas Konrad, M., Long Krogh, S., … Rønn Hansen, C. (2025). Impact of GTV-CTV margin and other predictors on radiation-induced dysphagia in head and neck cancer patients from DAHANCA group. Acta Oncologica, 64, 1253–1261. https://doi.org/10.2340/1651-226X.2025.44021

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Vol. 64 (2025): Acta Oncologica

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Copyright (c) 2025 Sarah Wordenskjold Stougaard, Ruta Zukauskaite , Richard Röttger , Ebbe Laugaard Lorenzen , Maximilian Lukas Konrad, Simon Long Krogh, Camilla Panduro Nielsen, Jeanette Frieda Aviaya Sommer , Jørgen Johansen , Jesper Grau Eriksen, Camilla Kjaer Lonkvist, Jeppe Friborg, Carsten Brink, Christian Rønn Hansen

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