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Caterina Finizia - One of the best experts on this subject based on the ideXlab platform.
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Jaw exercise therapy for the treatment of Trismus in head and neck Cancer: a prospective three-year follow-up study
Supportive Care in Cancer, 2020Co-Authors: Ove Karlsson, Paulin Andrell, Nina Pauli, Therese Karlsson, Caterina FiniziaAbstract:Purpose This study aims to examine effects of jaw exercise on Trismus 3 years following completion of a post-radiotherapy jaw exercise intervention. Methods Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), Trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. Results The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p
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image based data mining to probe dosimetric correlates of radiation induced Trismus
International Journal of Radiation Oncology Biology Physics, 2018Co-Authors: William J Beasley, Caterina Finizia, M Thor, Alan Mcwilliam, A Green, Ranald I Mackay, Nick Slevin, C Olsson, Niclas Pettersson, Cherry L EstiloAbstract:PURPOSE: To identify imaged regions in which dose is associated with radiation-induced Trismus after head and neck cancer radiation therapy (HNRT) using a novel image-based data mining (IBDM) framework. METHODS AND MATERIALS: A cohort of 86 HNRT patients were analyzed for region identification. Trismus was characterized as a continuous variable by the maximum incisor-to-incisor opening distance (MID) at 6 months after radiation therapy. Patient anatomies and dose distributions were spatially normalized to a common frame of reference using deformable image registration. IBDM was used to identify clusters of voxels associated with MID (P ≤ .05 based on permutation testing). The result was externally tested on a cohort of 35 patients with head and neck cancer. Internally, we also performed a dose-volume histogram-based analysis by comparing the magnitude of the correlation between MID and the mean dose for the IBDM-identified cluster in comparison with 5 delineated masticatory structures. RESULTS: A single cluster was identified with the IBDM approach (P < .01), partially overlapping with the ipsilateral masseter. The dose-volume histogram-based analysis confirmed that the IBDM cluster had the strongest association with MID, followed by the ipsilateral masseter and the ipsilateral medial pterygoid (Spearman's rank correlation coefficients: Rs = -0.36, -0.35, -0.32; P = .001, .001, .002, respectively). External validation confirmed an association between mean dose to the IBDM cluster and MID (Rs = -0.45; P = .007). CONCLUSIONS: IBDM bypasses the common assumption that dose patterns within structures are unimportant. Our novel IBDM approach for continuous outcome variables successfully identified a cluster of voxels that are highly associated with Trismus, overlapping partially with the ipsilateral masseter. Tests on an external validation cohort showed an even stronger correlation with Trismus. These results support use of the region in HNRT treatment planning to potentially reduce Trismus.
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exercise intervention for the treatment of Trismus in head and neck cancer a prospective two year follow up study
Acta Oncologica, 2016Co-Authors: Nina Pauli, Ulrika Svensson, Therese Karlsson, Caterina FiniziaAbstract:AbstractBackground This study aims to investigate the long-term effects of structured Trismus intervention in patients with head and neck cancer (HNC) and Trismus in terms of mouth opening, Trismus-related symptoms and health-related quality of life (HRQL).Material and methods Fifty patients with HNC to receive radiotherapy ± chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engstrom device). Patients were assessed before and after Trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included Trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & N...
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impact of Trismus on health related quality of life and mental health
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2015Co-Authors: Joakim Johnson, Mia Johansson, Anna Ryden, Erik Houltz, Caterina FiniziaAbstract:Background Trismus is a common symptom often related to the treatment for head and neck cancer and to temporomandibular disorders. The purpose of the present study was to measure the impact of Trismus on health-related quality of life (HRQOL) and mental health in patients with head and neck cancer and temporomandibular disorder. Methods We used the criteria for Trismus of maximum interincisal opening (MIO) ≤35 mm and the study subjects responded to the following instruments: the Gothenburg Trismus Questionnaire (GTQ), the Short-Form 36 Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). The study also comprised an age-matched and sex-matched control group without Trismus. Results Patients with Trismus reported significantly more dysfunction in all GTQ domains and more facial pain compared to the control group. The patients with head and neck cancer and Trismus scored significantly lower on all SF-36 domains except general health compared to the control group, and the patients with temporomandibular disorder with Trismus scored significantly lower in 3 of the 8 domains in SF-36. According to the HADS, a greater proportion of patients with head and neck cancer with Trismus displayed more depression compared to the control group. Conclusion The results showed that Trismus is associated with a significant impact on HRQOL and that patients with Trismus should be approached in a holistic way with respect for the underlying cause, treating not only the physical aspects of Trismus but also addressing the patients' mental health. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1672–1679, 2015
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exercise intervention for the treatment of Trismus in head and neck cancer
Acta Oncologica, 2014Co-Authors: Nina Pauli, Paulin Andrell, Bodil Fagerbergmohlin, Caterina FiniziaAbstract:AbstractBackground. The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on Trismus and its effect on Trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. Material and methods. Fifty patients with H&N cancer and Trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with Trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and Trismus-related symptoms were assessed. Results. The mean MIO improvement was 6.4 mm (4.8–8.0) and 0.7 (−0.3–1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically signifi...
Jan L. N. Roodenburg - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and prediction of Trismus in patients with head and neck cancer: A cross-sectional study.
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Sarah J. Van Der Geer, Phillip V. Van Rijn, Jolanda I. Kamstra, Johannes A. Langendijk, Bernard F. A. M. Van Der Laan, Jan L. N. Roodenburg, Pieter U. DijkstraAbstract:BACKGROUND: Trismus occurs frequently in patients with head and neck cancer. Determining the prevalence and associated factors of Trismus would enable prediction of the risk of Trismus for future patients. METHODS: Based on maximal mouth opening measurements, we determined the prevalence of Trismus in 730 patients with head and neck cancer. Associated factors for Trismus were analyzed using univariate analyses and multivariate logistic regression analyses. Based on the regression model, a calculation tool to predict Trismus was made. RESULTS: Prevalence of Trismus was 23.6%. Factors associated with Trismus were: advanced age; partial or full dentition; tumors located at the maxilla; mandible; cheek; major salivary glands; oropharynx; an unknown primary; a free soft tissue transfer after surgery; reirradiation; and chemotherapy. CONCLUSION: About one-fourth of patients with head and neck cancer develop Trismus. Based on prevalence and associated factors of Trismus, a simple calculation tool predicts the risk of Trismus in these patients.
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predictors for Trismus in patients receiving radiotherapy
Acta Oncologica, 2016Co-Authors: Joyce S Van Der Geer, Jolanda I. Kamstra, Johannes A. Langendijk, Jan L. N. Roodenburg, Marianne Van Leeuwen, Harry Reintsema, Pieter U. DijkstraAbstract:AbstractBackground: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of Trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of Trismus after radiotherapy in head and neck cancer patients using a large database (n = 641).Methods: Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for Trismus using a multivariable logistic regression analysis.Results: At six months after radiotherapy, 28.1% of the patients without Trismus prior to radiotherapy developed Trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy...
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dynasplint Trismus system exercises for Trismus secondary to head and neck cancer a prospective explorative study
Supportive Care in Cancer, 2016Co-Authors: Jolanda I. Kamstra, Jan L. N. Roodenburg, Harry Reintsema, Pieter U. DijkstraAbstract:Purpose The Dynasplint Trismus System (DTS) can be used to treat Trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients’ perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance.
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Trismus in patients with head and neck cancer etiopathogenesis diagnosis and management
Clinical Otolaryngology, 2015Co-Authors: Alexander D Rapidis, Jan L. N. Roodenburg, Pieter U. Dijkstra, Juan P Rodrigo, Alessandra Rinaldo, Primož Strojan, Robert P Takes, Alfio FerlitoAbstract:Background: Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as Trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of Trismus in patients with head and neck cancer. Objective of review: Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of Trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with Trismus after tumour treatment, it is important to determine whether the Trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up. Conclusions: Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of Trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced Trismus. Treatment of Trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of Trismus, rather than its treatment, is the most important objective.
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variation in repeated mouth opening measurements in head and neck cancer patients with and without Trismus
International Journal of Oral and Maxillofacial Surgery, 2009Co-Authors: Harriet Jagerwittenaar, Pieter U. Dijkstra, Arjan Vissink, Van Robert Oort, Jan L. N. RoodenburgAbstract:Abstract Trismus after head and neck cancer treatment may severely limit mandibular functioning. Interventions aimed at reducing Trismus can only be evaluated when the amount of variation associated with these measurements is known. The aim of this study was to analyse the variation in mouth-opening measurements in patients treated for head and neck cancer, with and without Trismus. Maximal mouth opening was measured in 120 patients in two sessions of three repeated measurements by one observer. To analyse the influence of interobserver variation on mouth-opening measurements a subgroup of 30 patients was measured by a second observer. The standard deviation of the six measurements per patient was used as the variation in measurements of maximal mouth opening. No significant difference was found in maximal mouth opening in patients with ( n =33) or without ( n =87) Trismus. The interobserver intraclass correlation coefficient (ICC) was 0.98. Intraobserver ICC and intersession ICC reliabilities both were 0.99. The variation in the mean values of the three measurements was only slightly smaller than the variation of the single measurements. Variation in maximal mouth opening in patients with Trismus does not differ from variation in maximal mouth opening in patients without Trismus. Interobserver variation is limited.
Pieter U. Dijkstra - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and prediction of Trismus in patients with head and neck cancer: A cross-sectional study.
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Sarah J. Van Der Geer, Phillip V. Van Rijn, Jolanda I. Kamstra, Johannes A. Langendijk, Bernard F. A. M. Van Der Laan, Jan L. N. Roodenburg, Pieter U. DijkstraAbstract:BACKGROUND: Trismus occurs frequently in patients with head and neck cancer. Determining the prevalence and associated factors of Trismus would enable prediction of the risk of Trismus for future patients. METHODS: Based on maximal mouth opening measurements, we determined the prevalence of Trismus in 730 patients with head and neck cancer. Associated factors for Trismus were analyzed using univariate analyses and multivariate logistic regression analyses. Based on the regression model, a calculation tool to predict Trismus was made. RESULTS: Prevalence of Trismus was 23.6%. Factors associated with Trismus were: advanced age; partial or full dentition; tumors located at the maxilla; mandible; cheek; major salivary glands; oropharynx; an unknown primary; a free soft tissue transfer after surgery; reirradiation; and chemotherapy. CONCLUSION: About one-fourth of patients with head and neck cancer develop Trismus. Based on prevalence and associated factors of Trismus, a simple calculation tool predicts the risk of Trismus in these patients.
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predictors for Trismus in patients receiving radiotherapy
Acta Oncologica, 2016Co-Authors: Joyce S Van Der Geer, Jolanda I. Kamstra, Johannes A. Langendijk, Jan L. N. Roodenburg, Marianne Van Leeuwen, Harry Reintsema, Pieter U. DijkstraAbstract:AbstractBackground: Trismus, a restricted mouth opening in head and neck cancer patients may be caused by tumor infiltration in masticatory muscles, radiation-induced fibrosis or scarring after surgery. It may impede oral functioning severely. The aims of our study were to determine: (1) the incidence of Trismus at various time points; and (2) the patient, tumor, and treatment characteristics that predict the development of Trismus after radiotherapy in head and neck cancer patients using a large database (n = 641).Methods: Maximal mouth opening was measured prior to and 6, 12, 18, 24, 36, and 48 months after radiotherapy. Patient, tumor, and treatment characteristics were analyzed as potential predictors for Trismus using a multivariable logistic regression analysis.Results: At six months after radiotherapy, 28.1% of the patients without Trismus prior to radiotherapy developed Trismus for the first time. At subsequent time points the incidence declined. Over a total period of 48 months after radiotherapy...
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dynasplint Trismus system exercises for Trismus secondary to head and neck cancer a prospective explorative study
Supportive Care in Cancer, 2016Co-Authors: Jolanda I. Kamstra, Jan L. N. Roodenburg, Harry Reintsema, Pieter U. DijkstraAbstract:Purpose The Dynasplint Trismus System (DTS) can be used to treat Trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients’ perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance.
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Trismus in patients with head and neck cancer etiopathogenesis diagnosis and management
Clinical Otolaryngology, 2015Co-Authors: Alexander D Rapidis, Jan L. N. Roodenburg, Pieter U. Dijkstra, Juan P Rodrigo, Alessandra Rinaldo, Primož Strojan, Robert P Takes, Alfio FerlitoAbstract:Background: Trismus indicates severely restricted mouth opening of any aetiology. A mouth opening of 35 mm or less should be regarded as Trismus. Aim of this study was to review the etiopathogenesis, incidence, treatment and prevention of Trismus in patients with head and neck cancer. Objective of review: Trismus is frequently seen in patients suffering from malignant tumours of the head and neck. The reported prevalence of Trismus in those patients varies considerably in the literature and ranges from 0 to 100% depending on the tumour site and extension. Trismus may worsen or remain the same over time, or the symptoms may reduce, even in the absence of treatment. When a patient presents with Trismus after tumour treatment, it is important to determine whether the Trismus is the result of the treatment, or is the first sign of a recurrence. Restricted mouth opening may impede inspection of the oral cavity as needed for dental care, and particularly for oncologic follow-up. Conclusions: Mouth opening after radiotherapy (RT) decreases on average by approximately 20% compared to mouth opening prior to RT. The prevalence of Trismus increases with increasing doses of RT to mastication structures. The use of intensity-modulated RT seems to lower the percentage and severity of RT-induced Trismus. Treatment of Trismus can be conservative (with either medical or physical therapy) or surgical. Exercise therapy is the mainstay of treatment and exercise should start as soon as possible after treatment. The prevention of Trismus, rather than its treatment, is the most important objective.
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variation in repeated mouth opening measurements in head and neck cancer patients with and without Trismus
International Journal of Oral and Maxillofacial Surgery, 2009Co-Authors: Harriet Jagerwittenaar, Pieter U. Dijkstra, Arjan Vissink, Van Robert Oort, Jan L. N. RoodenburgAbstract:Abstract Trismus after head and neck cancer treatment may severely limit mandibular functioning. Interventions aimed at reducing Trismus can only be evaluated when the amount of variation associated with these measurements is known. The aim of this study was to analyse the variation in mouth-opening measurements in patients treated for head and neck cancer, with and without Trismus. Maximal mouth opening was measured in 120 patients in two sessions of three repeated measurements by one observer. To analyse the influence of interobserver variation on mouth-opening measurements a subgroup of 30 patients was measured by a second observer. The standard deviation of the six measurements per patient was used as the variation in measurements of maximal mouth opening. No significant difference was found in maximal mouth opening in patients with ( n =33) or without ( n =87) Trismus. The interobserver intraclass correlation coefficient (ICC) was 0.98. Intraobserver ICC and intersession ICC reliabilities both were 0.99. The variation in the mean values of the three measurements was only slightly smaller than the variation of the single measurements. Variation in maximal mouth opening in patients with Trismus does not differ from variation in maximal mouth opening in patients without Trismus. Interobserver variation is limited.
Nina Pauli - One of the best experts on this subject based on the ideXlab platform.
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Jaw exercise therapy for the treatment of Trismus in head and neck Cancer: a prospective three-year follow-up study
Supportive Care in Cancer, 2020Co-Authors: Ove Karlsson, Paulin Andrell, Nina Pauli, Therese Karlsson, Caterina FiniziaAbstract:Purpose This study aims to examine effects of jaw exercise on Trismus 3 years following completion of a post-radiotherapy jaw exercise intervention. Methods Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), Trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. Results The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p
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exercise intervention for the treatment of Trismus in head and neck cancer a prospective two year follow up study
Acta Oncologica, 2016Co-Authors: Nina Pauli, Ulrika Svensson, Therese Karlsson, Caterina FiniziaAbstract:AbstractBackground This study aims to investigate the long-term effects of structured Trismus intervention in patients with head and neck cancer (HNC) and Trismus in terms of mouth opening, Trismus-related symptoms and health-related quality of life (HRQL).Material and methods Fifty patients with HNC to receive radiotherapy ± chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engstrom device). Patients were assessed before and after Trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included Trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & N...
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exercise intervention for the treatment of Trismus in head and neck cancer
Acta Oncologica, 2014Co-Authors: Nina Pauli, Paulin Andrell, Bodil Fagerbergmohlin, Caterina FiniziaAbstract:AbstractBackground. The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on Trismus and its effect on Trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. Material and methods. Fifty patients with H&N cancer and Trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with Trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and Trismus-related symptoms were assessed. Results. The mean MIO improvement was 6.4 mm (4.8–8.0) and 0.7 (−0.3–1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically signifi...
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the incidence of Trismus and long term impact on health related quality of life in patients with head and neck cancer
Acta Oncologica, 2013Co-Authors: Nina Pauli, Joakim Johnson, Caterina Finizia, Paulin AndrellAbstract:AbstractBackground. Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of Trismus and the patients’ experience of Trismus in daily life activities. The aim of the study was to assess the incidence of Trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. Material and methods. We used the criteria for Trismus of maximum interincisal opening (MIO) ≤ 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). Results. The incidence of Trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the ton...
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development and validation of the gothenburg Trismus questionnaire gtq
Oral Oncology, 2012Co-Authors: Joakim Johnson, Mia Johansson, Anna Ryden, Nina Pauli, Bodil Fagerbergmohlin, Sigrid Carlsson, Caterina FiniziaAbstract:Summary Objectives To develop and validate a comprehensive, self-administered questionnaire for patients with limited ability to open the mouth, Trismus. Materials and methods We derived the Gothenburg Trismus Questionnaire (GTQ) from empirical evidence in the medical literature and interviews with medical experts as well as patients. The draft version was tested in a pilot study (n = 18). Patients with a maximal incisal opening (MIO) of ⩽35 mm were included. The study comprised patients with benign jaw-related conditions (n = 51), patients treated for head and neck (H&N) cancer (n = 78) and an age- and gender-matched control group without Trismus (n = 129). Results The GTQ instrument was well accepted by the patients, with satisfactory compliance and low rates of missing items. After item reduction, due to items not being conceptually relevant and/or low factor loadings, the GTQ demonstrated high internal consistency (Cronbach’s alpha 0.72–0.90), good construct validity and known-group validity. Conclusion We developed a Trismus-specific self-administered questionnaire, the GTQ, that showed good psychometric properties. We suggest this questionnaire, that has clear clinical relevance, to be adopted and used in clinical practice and in research, acting as a screening tool as well as an endpoint in intervention and jaw physiotherapy/rehabilitation studies.
Joseph O Deasy - One of the best experts on this subject based on the ideXlab platform.
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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
Physics and Imaging in Radiation Oncology, 2017Co-Authors: M Thor, Neelam Tyagi, Z Saleh, Nadeem Riaz, Vaios Hatzoglou, A Apte, Joseph O DeasyAbstract:Abstract Background and purpose In this study we investigated the ability of textures from T1-weighted MRI scans post-contrast (T1w post ) 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 T1w Post 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.
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we fg 202 07 an mri based approach to quantify radiation induced normal tissue injury applied to Trismus after head and neck cancer radiotherapy
Medical Physics, 2016Co-Authors: M Thor, Neelam Tyagi, V Hazoglou, Z Saleh, Nadeem Riaz, Joseph O DeasyAbstract:Purpose: The aim of this study was to investigate if quantitative MRI-derived metrics from four masticatory muscles could explain mouth-opening limitation/Trismus following intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC). Methods: Fifteen intensity-based MRI metrics were derived from the masseter, lateral and medial pterygoid, and temporalis in T1-weighted scans acquired pre- and post gadolinium injection (T1Pre, T1Post) of 16, of in total 20, patients (8 symptomatic; 8 asymptomatic age/sex/tumor location-matched) treated with IMRT to 70 Gy (median) for HNC in 2005–2009. Trismus was defined as “≥decreased range of motion without impaired eating” (CTCAE.v.3: ≥Grade 1). Trismus status was monitored and MRI scans acquired within 1y post-RT. All MRI-derived metrics were assessed as ΔS=S(T1Pre)-S(T1Post)/S(T1Pre), and were normalized to the corresponding metric of a non-irradiated volume defined in each scan. The T1Pre structures were propagated onto the RT dose distribution, and the max and mean dose (Dmax, Dmean) were extracted. The MRI-derived metrics, Dmax, and Dmean were compared between Trismus and non-Trismus patients. A two-sided Wilcoxon Signed rank test-based p-value≤0.05 denoted significance. Results: For all four muscles the population mean of Dmax and Dmean was higher for patients with Trismus compared to patients without Trismus (ΔDmax=2.3–4.9 Gy; ΔDmean=and 2.0–3.8 Gy). The standard deviation (SD), the variance, and the minimum value (min) of ΔS were significantly (p=0.04–0.05) different between patients with and without Trismus with Trismus patients having significantly lower SD (population median: −0.53 vs. −0.31) and variance (−2.09 vs. −0.73) of the masseter, and significantly lower min of the medial pterygoid (−0.36 vs. −0.19). Conclusion: Quantitative MRI-derived metrics of two masticatory muscles were significantly different between patients with and without Trismus following RT for HNC. These metrics could serve as image-based biomarkers to better understand the RT-induced etiology behind Trismus, but should be further investigated in the complete cohort.
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dose volume factors correlating with Trismus following chemoradiation for head and neck cancer
Acta Oncologica, 2016Co-Authors: Z Saleh, Nadeem Riaz, J Setton, S Mcbride, Joseph O DeasyAbstract:Background. To investigate the dose-volume factors in mastication muscles that are implicated as possible causes of Trismus in patients following treatment with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy for head and neck cancers.Material and methods. All evaluable patients treated at our institution between January 2004 and April 2009 with chemotherapy and IMRT for squamous cell cancers of the oropharynx, nasopharynx, hypopharynx or larynx were included in this analysis (N = 421). Trismus was assessed using CTCAE 4.0. Bi-lateral masseter, temporalis, lateral pterygoid and medial pterygoid muscles were delineated on axial computed tomography (CT) treatment planning images, and dose-volume parameters were extracted to investigate univariate and multimetric correlations.Results. Forty-six patients (10.9%) were observed to have chronic Trismus of grade 1 or greater. From analysis of baseline patient characteristics, toxicity correlated with primary site and patient age. From dose-vol...
