Characterization of Toxicities Associated with Radiation Therapy for Head and Neck Lymphomas

Although toxicities for HNSCC are well described, toxicities of patients with HNL treated with modern low radiation doses and advanced RT techniques to involved site RT volumes are poorly characterized in the literature. Fear of toxicity may contribute to hesitancy to recommend RT by managing oncologists. Characterization of these toxicities would be helpful when counseling patients with HNL. This is a retrospective cohort study of HN patients treated with a first course of RT who had at least 3 months of follow-up. Toxicities were collected prospectively by care providers using CTC AE version 4.0 grading system that was built into progress note templates in the electronic medical record. From January 2007 to June 2016, 63 HNL patients were treated (50 with non-Hodgkin, 13 Hodgkin lymphoma), median age (64, range 26 to 85), 48% Stage I, 22% Stage II, 3% Stage III, 27% Stage IV. 66% were nonsmokers. As an internal control to validate our toxicity collection methods, we compared the HNL patients to 293 HNSCC patients (median age 60, range 6 to 92) whose toxicities were captured with the same method. Of the HNSCC patients, the majority (82.5%) had Stage IV disease, and 158 (54%) received concurrent chemotherapy. 43% were nonsmokers. Median RT doses were 66 Gy (range 28-80 Gy) for HNSCC and 30.6 Gy (range 18-50.4 Gy) for HNL patients. Rates of Grade 2 and higher toxicities were compared using Fisher’s exact test. The percentage of patients with Grade 2 and higher toxicities are reported in the Table. There was no significant difference in fatigue, however Grade ≥2 anorexia, xerostomia, mucositis, dysguesia, dysphagia, and dermatitis were all significantly lower in HNL patients. Although rates of Grade ≥2 toxicities were low in HNL patients (generally less than 20%), the rates of Grade 1 and higher occurred frequently despite the low doses (xerostomia 62%, dysguesia 41%, dysphagia 35%, dermatitis 51%).Abstract 3029; Table of Grade ≥2 ToxicitesHNSCC (%)HNL (%)p valueFatigue16190.582Anorexia43220.003Xerostomia1320.004Mucositis358<0.001Dysgeusia5111<0.001Dysphagia5017<0.001Dermatitis493<0.001 Open table in a new tab Radiation for HN lymphoma is far less toxic than for HNSCC, but there is still a reasonably high rate of grade 1 toxicities. These data will be useful for communicating expected toxicity rates to patients, dental professionals and referring providers.