Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Radiation-induced fibrosis is a progressive process that can lead to a multitude of functional impairments, decreased quality of life, and increased mortality in head and neck cancer (HNC) survivors. Therefore, more accurate methods of evaluating changes to the soft tissue, muscles, and functional sequelae are needed. Using elastography to assess the degree of radiation fibrosis, we aim to investigate the relationship between radiation fibrosis with muscle strength, range of motion, and symptoms among HNC survivors who have undergone radiation therapy.
Methods: This study was a prospective case-control pilot study. Ten survivors who had completed radiation therapy for squamous cell carcinoma of the oropharynx and/or laryngopharynx were identified as eligible participants and enrolled. Ten healthy age and sex-matched controls were enrolled through a university online research registry. Patients who had clinical evidence of distant metastases, underwent surgical resection, or were unable to remain in prone and supine positions were excluded. Self-reported demographics and validated surveys of neck pain and disability were collected. Cancer and treatment characteristics were obtained from electronic medical records. Head and neck muscle morphology and stiffness were measured using B-mode ultrasound imaging and shear wave elastography. Neck range of motion, muscle strength, and muscle endurance were evaluated. Group statistics were used to compare outcomes between survivors and controls.
Results: The matching process resulted in the same median age (65.5 years), sex (90% male), and marital status (90% married) distribution for survivors and controls and a small difference in race, with 80% of survivors and 90% of controls of white race. The most common tumor site for the HNC survivors was the oropharynx (n=7, 70%), with the majority presenting with T2 (n=4, 40%) or T3 (n=3, 30%) disease and nodal disease (N1: n=6, 60%; N2: n=2, 20%) present. The mean radiation dose was 69.9 0.7Gy, and the median time since treatment completion was 24.5 months [12.0, 70.3]. HNC survivors had significantly more pain with flexion, extension, rotation in full flexion (left), rotation in neutral flexion (left, right), and lateral bending (left, right) (p<.05) on range of motion testing. NC survivors exhibited limited neck range of motion compared to healthy controls, with rotation in neutral flexion (p=0.011) and lateral flexion (p=0.010). HNC survivors also demonstrated reduced isometric strength with lateral bending (right: p=0.008; Left: p=0.003). While these participants generally had less muscle thickness and more stiffness, there was no significant between-group difference.
Conclusions: HNC survivors exhibit notable impairments in musculoskeletal function compared to healthy peers. In our study, HNC survivors presented increased pain, reduced neck range of motion, and diminished isometric strength, particularly during neck lateral bending. While ultrasound and elastography are feasible technologies to characterize changes in muscle morphology and stiffness, additional studies with larger sample sizes are warranted. These findings highlight the long-term impact of cancer treatment and emphasize the need for targeted rehabilitation strategies to address musculoskeletal dysfunction among HNC survivors. The given data underscores the importance of routine functional assessments to guide survivorship care and optimize outcomes in this population.