Definitions of Radiation-induced Trismus in Head and Neck Cancer: Current Concepts and Controversies (original) (raw)
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Impact of Radiation-induced Trismus on Patients’ Life Quality
Archives of Current Research International
Head and neck cancers (HNC) account for 10–15% of all cancers globally. Curative radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) with or without surgery are widely accepted standard treatment modalities for these patients. Radiation-induced fibrosis is one of the side effects of these treatments, and it causes degeneration, inflammation, pain, and atrophy of the masticatory muscle fibers and the temporomandibular joint, resulting in trismus. Trismus, also known as hypomobility of the mouth, is defined as a restricted opening of the mouth. Radiation-induced trismus (RIT) can occur within the first three months of treatment or up to 12–48 months later during the follow-up period. It has a significant negative influence on daily activities and vital oral functions, including speech problems, difficulty eating or drinking, psychological problems, malnutrition, dehydration, and difficulty with oral hygiene, reducing the quality of life (QoL). Given the underappreciated nat...
Dose-volume analysis of radiation-induced trismus in head and neck cancer patients
Acta oncologica (Stockholm, Sweden), 2016
Trismus is a treatment-related late side effect in patients treated for cancer in the head and neck region (HNC). The condition can have a considerable negative impact on nutrition, dental hygiene, ability to speak and quality of life. We have previously studied trismus within the frame of a randomized phase 3 study of HNC patients treated with mainly three-dimensional (3D) conformal radiotherapy (CRT) and found a strong association to mean radiation dose to the mastication muscles, especially the ipsilateral masseter muscle (iMAS). In the present study we have investigated trismus prevalence and risk factors in a more recent cohort of patients, treated with todays' more updated radiation techniques. Maximal interincisal distance (MID) was measured on 139 consecutive patients. Trismus was defined as MID ≤35 mm. Patient-, disease- and treatment-specific data were retrospectively recorded. Differences between groups were analyzed and mean absorbed dose to mastication structures wa...
A Comprehensive Review of the Pros and Cons of Definitions of Radiation-Induced Trismus
Journal of advances in medicine and medical research, 2022
Radiation therapy is the most common cause of cancer-related trismus. Radiation therapy can lead to fibrosis and hypoxia in the temporomandibular joint ligaments, synovial fluid, and masticatory muscles. This makes it difficult for patients to move their jaws and eventually leads to restricted mouth opening. This devastating complication is called radiation-induced trismus, which occurs after radiation therapy in patients with head and neck cancers and affects their daily routine functions such as eating, speaking, chewing, swallowing, and oral hygiene habits, as well as impairs their psychosocial communication and decreases their quality of life. The evaluation in radiation-induced trismus determination is basically performed by measuring the maximum mouth opening. Previous studies evaluating radiation-induced trismus have used many maximum mouth opening cutoff values such as 40 mm, 35 mm, 30 mm, and 20 mm. The fact that no common and valid language is used to establish cutoff values means that the impact and prevalence of this serious complication are not fully revealed. In the absence of a widely accepted maximum mouth opening cutoff value or range for radiation-induced trismus definition that applies to all patients with head and neck cancers, a patient may be labeled as trismus in some studies but non-trismus in
Radiation-induced trismus in the ARTSCAN head and neck trial
Acta Oncologica, 2014
Trismus, a well-known sequelae after treatment of head and neck cancer, decreases a patient's oral function and quality of life. The main objectives of this study were to: 1) investigate the long-term prevalence of radiation-induced trismus in patients treated for head and neck cancer according to two different fractionation schedules; and 2) model a dose-response relationship for trismus. Material and methods. Patients were recruited from the Swedish ARTSCAN trial, a prospective randomised multicentre study comparing conventional and accelerated fractionation. A total of 124 patients agreed to a clinical ENT examination 21-127 months (median 66 months) after beginning radiation therapy. Trismus-related scores were assessed using the EORTC H&N35 Quality of Life questionnaire. The TheraBite ® range of motion scale was used to measure maximal interincisal distance. The dose-response relationship for structures important for mastication and the temporomandibular joints was investigated by normal tissue complication probability modelling. results. No significant differences in patient-reported trismus or maximal interincisal distance were found between the two trial arms. Patient-reported moderate to high scores regarding trismus increased from 3% at the start of radiation therapy to 25% at the long-term follow-up. Maximal interincisal distance correlated significantly with patient-reported scores of trismus. The best dose-response fit to the endpoint data was found for the dose to the ipsilateral masseter. conclusions. Trismus is a persistent complication after radiotherapy with 3D-conformal radiation therapy. We found no difference between the severity and prevalence of trismus between conventional and accelerated fractionation, but a significant correlation between the absorbed dose to the mastication structures and opening of the mouth. Further prospective studies may determine whether a reduced dose to structures important for mastication using intensitymodulated radiation therapy will reduce problems with trismus.
Trismus significantly impacts activities of daily living as well as vital oral function; it is associated with speech problems, difficulty in eating or drinking, malnutrition, dehydration, difficulty with oral hygiene,and lower quality of life. This study was aimed at studying the severity of trismus in oral carcinoma patients receiving radiotherapy, its impact on quality of life in such patients and to identify contributing risk factors and their prevention. A prospective study was carried out in Department of Otorhinolaryngology, Silchar Medical College and Hospital, Silchar during a period of one and half year. Patients with newly diagnosed squamous cell carcinoma of oral cavity irrespective of age and sex were included in the study. Baseline Maximal interincisal opening was measured at the time of diagnosis, after completion of radiotherapy, 3 months after radiotherapy and 6 months after radiotherapy. Quality of life was assessed using EORTC-QLQ H&N35 and CTCAEv4.0 was used for grading of trismus. A total of 40 patients were analysed during the study period. Maximal interincisal opening was significantly lower after completion of radiotherapy. Patients starting rehabilitative exercises soon had better Maximal Interincisal Opening than others. Higher grades of trismus lead to poorer Quality of Life among carcinoma oral cavity patients. Hence we concluded that there is significant decrease in mouth opening following teletharapy with Co 60 in carcinoma oral cavity patients. Trismus adds significantly to the morbidities of carcinoma oral cavity patients. Rehabilitative measures should be explained and made to follow at earliest to prevent developing higher grades of trismus
Predictors for trismus in patients receiving radiotherapy
Acta Oncologica, 2016
Background: 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 ¼ 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, the incidence of trismus was 3.6 per 10 person years at risk. Patients who had tumors located in the oral cavity, oropharynx or nasopharynx, and the salivary glands or ear, and who had a longer overall treatment time of radiotherapy, were more likely to develop trismus in the first six months after radiotherapy. Maximal mouth opening was a predictor for developing trismus at all time points. Conclusion: Incidence of trismus is 3.6 per 10 person years at risk. Tumor localization and overall treatment time of radiotherapy are predictors for developing trismus the first six months after radiotherapy. Maximal mouth opening is a significant predictor for developing trismus at all time points. Regular measurements of maximal mouth opening are needed to predict trismus.
Journal of Clinical Oncology
222 Background: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Methods: Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and reduced mouth opening-trismus, surviving with reduced quality of life (QoL). We aimed to study trismus and QoL in patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy. Results: Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient...
Sumathi Publications, 2020
Background: Trismus is a restricted mouth opening due to the tonic contraction of muscles of mastication. It may occur mostly in HNF cancer patients undergoing radiation therapy treatment. This study was undertaken with the purpose of finding out the prevalence of trismus in patients undergoing radiation therapy. Method: 89 patients with HNF cancer patients receiving radiation therapy were included in the study. Inter incisal distance was measured using sliding digital vernier calliper. Patients with ≥ 35mm mouth opening were considered as trismus cases. Result: Out of 89 patients included 72 were diagnosed as trismus; hence the prevalence was 81%. Conclusion: Prevalence of Trismus is very high (81 %) in patients undergoing radiotherapy secondary to HNF cancer. Early diagnosis of trismus in these patients can help in time management and also planning of preventive strategies.
Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study
Oral oncology, 2015
Aims of this prospective cohort study were (1) to analyze the course of mouth opening up to 48months post-radiotherapy (RT), (2) to assess risk factors predicting decrease in mouth opening, and (3) to develop a multivariable prediction model for change in mouth opening in a large sample of patients irradiated for head and neck cancer. Mouth opening was measured prior to RT (baseline) and at 6, 12, 18, 24, 36, and 48months post-RT. The primary outcome variable was mouth opening. Potential risk factors were entered into a linear mixed model analysis (manual backward-stepwise elimination) to create a multivariable prediction model. The interaction terms between time and risk factors that were significantly related to mouth opening were explored. The study population consisted of 641 patients: 70.4% male, mean age at baseline 62.3years (sd 12.5). Primary tumors were predominantly located in the oro- and nasopharynx (25.3%) and oral cavity (20.6%). Mean mouth opening at baseline was 38.7...