Impact of Radiation-induced Trismus on Patients’ Life Quality (original) (raw)
Related papers
Definitions of Radiation-induced Trismus in Head and Neck Cancer: Current Concepts and Controversies
Exon Publications eBooks, 2022
Radiation-induced trismus is a devastating side effect of radiotherapy in patients with head and neck cancers. It hampers daily activities like eating, speaking, chewing, swallowing, and oral hygiene routines. Radiation-induced trismus also negatively affects social interactions, psychological wellbeing, and lowers the quality of life of patients. The most common method for determining radiationinduced trismus is to measure the 'maximum mouth opening'. Different cutoff Somay E et al. 24 values for maximum mouth opening have been employed in studies that assessed radiation-induced trismus, including 40 mm, 35 mm, 30 mm, and 20 mm. The impact and prevalence of radiation-induced trismus are not fully understood because there is no common and reliable objective measure to determine cutoff values of maximum mouth opening. Additionally, regardless of the pretreatment measures, a standard cutoff is applied to all patients, where a change may be substantial for one patient but not necessarily for another. These discrepancies may cause certain patients' conditions to be overstated or understated, misdirecting their prophylactic or therapeutic interventions. This chapter highlights the current concepts and controversies of the definitions of radiation-induced trismus, and the possible challenges in managing radiation-induced trismus because of the varied definitions.
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...
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
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
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.
Research Square (Research Square), 2022
Background Trismus is a common adverse effect in patients with head and neck cancer. Patients have a limitation of mouth opening (< 35mm), which can compromise maxillomandibular function. The cancer treatment itself can lead to its emergence, with surgery and radiotherapy being the most involved. This study aimed to evaluate the e cacy of a PBMT protocol for treating and reducing the severity of trismus in patients undergoing radiotherapy for head and neck cancer. Material and Methods Sixteen patients who had a mouth opening < 35mm and were undergoing RT were included. The patients were evaluated daily before and after the PBMT application, measuring mouth opening and performing pain scores for the masticatory muscles using the VAS scale. We used the infrared laser (~ 808nm) extraoral, 0.1W power, 3J energy, 30s (30.61/cm2) per point, applied to temporalis anterior, masseter, and TMJ muscles. We used one intraoral point with the same wavelength and energy density as the others for the medial pterygoid muscle. Results The mean mouth opening of the patients increased by more than 7 mm throughout the treatment. The pain scores on the initial days showed an immediate reduction after PBMT on the ipsilateral side in the muscles and TMJ. Throughout PBMT applications, there was a signi cant reduction in pain scores in all muscles and the TMJ. The radiation dose of all patients was above 40Gy, which is the threshold dose for the risk of developing trismus. PBMT in patients with mouth opening < 35mm has been responsible for long-term improvement in mouth opening limitation and pain during mouth opening. Conclusion It is suggested that PBMT helps in pain control by anti-in ammatory muscle pathways. Further studies are needed to evaluate the preventive capacity of this or other PBMT protocols in trismus related to RT of HNC.
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...
PLoS ONE, 2014
To develop magnetic resonance imaging (MRI) indicators to predict trismus outcome for post-operative oral cavity cancer patients who received adjuvant intensity-modulated radiation therapy (IMRT), 22 patients with oral cancer treated with IMRT were studied over a two-year period. Signal abnormality scores (SA scores) were computed from Likert-type ratings of the abnormalities of nine masticator structures and compared with the Mann-Whitney U-test and Kruskal-Wallis one-way ANOVA test between groups. Seventeen patients (77.3%) experienced different degrees of trismus during the two-year follow-up period. The SA score correlated with the trismus grade (r = 0.52, p,0.005). Patients having progressive trismus had higher mean doses of radiation to multiple structures, including the masticator and lateral pterygoid muscles, and the parotid gland (p,0.05). In addition, this group also had higher SA-masticator muscle dose product at 6 months and SA scores at 12 months (p,0.05). At the optimum cut-off points of 0.38 for the propensity score, the sensitivity was 100% and the specificity was 93% for predicting the prognosis of the trismus patients. The SA score, as determined using MRI, can reflect the radiation injury and correlate to trismus severity. Together with the radiation dose, it could serve as a useful biomarker to predict the outcome and guide the management of trismus following radiation therapy.