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Radiotherapy and Smell Function in Head and Neck Cancer: A Nonrandomized Clinical Trial.

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Radiotherapy (RT) for head and neck cancer (HNC) can cause smell dysfunction. A dose of 22 Gy to the olfactory region is a key threshold, with higher doses increasing the risk of long-term olfactory impairment.

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Area of Science:

  • Oncology
  • Radiotherapy
  • Otolaryngology

Background:

  • Head and neck cancer (HNC) patients often experience smell dysfunction after radiotherapy (RT).
  • Limited prospective data exist on smell dysfunction, particularly with intensity-modulated RT (IMRT).

Purpose of the Study:

  • To assess the association between RT and olfactory function in HNC patients undergoing IMRT.
  • To track changes in olfactory function over time post-treatment.

Main Methods:

  • A nonrandomized clinical trial included 63 HNC patients treated with IMRT.
  • Olfactory function was assessed using the Taiwan Smell Identification Test before, during, and up to 12 months after RT.
  • Nasal endoscopy ruled out confounding nasal conditions.

Main Results:

  • A moderate positive correlation was found between radiation dose and olfactory dysfunction.
  • An olfactory region radiation dose exceeding 22 Gy was identified as an independent risk factor for olfactory dysfunction (OR, 20.65).
  • Persistent olfactory dysfunction was observed in some patients up to 1 year post-RT.

Conclusions:

  • RT demonstrates a dose-dependent association with olfactory dysfunction in HNC patients.
  • 22 Gy serves as a critical threshold dose for estimating olfactory impairment.
  • Optimizing RT planning to reduce radiation dose to the olfactory region may mitigate long-term olfactory dysfunction.