Radiotherapy Induced Taste Dysfunction During and 3 Months After Treatment in Head and Neck Cancer

Patients with head and neck cancer experienced taste dysfunction during treatment with radiotherapy and 3 months after; however, early recovery was observed among patients who received a reduced dose of intensity-modulated radiotherapy (IMRT) to the oral cavity, according to a study published in JAMA Otolaryngology-Head &Neck Surgery.

Taste dysfunction was observed in 91.9% of patients during treatment, 75.9% experienced it at 1 week, 33.3% at 3 months, 8.9% at 6 months, and 6.7% at 1 year. In a univariate analysis, an oral cavity mean dose of 4000 cGy or greater (relative risk [RR], 2.87; 95% CI, 1.21-6.81) or 5000 cGy (RR, 2.04; 95% CI, 1.12-3.72) 3 months after radiotherapy In addition to partial glossectomy (RR, 5.63; 95% 1.12-28.15) and an oral cavity mean dose of 5000 cGy or more (RR, 7.79; 95% CI, 0.93-64.92) 6 months following radiotherapy was associated with taste dysfunction.

A total of 87 patients enrolled on the study and received either primary radiotherapy (n = 45) or postoperative radiotherapy (n = 42). Radiotherapy was either delivered through volumetric modulated arc therapy (n = 78) or IMRT (n = 9). For those with a macroscopic tumor, treatment consisted of 60.0 Gy to 74.0 Gy, surgical tumors received 60.0 Gy to 72.0 Gy, and those with subclinical disease received 46 Gy to 50 Gy, given at 1.8 Gy to 2 Gy per fraction. In the study, 63 patients received concurrent chemotherapy, with 15 patients receiving induction chemotherapy.

Prior to radiotherapy, all patients in the trial had normal taste functions, but 2 to 4 weeks after receiving radiotherapy taste dysfunction began. Taste scores for salt decreased from baseline 4.7 to 1.4 for salt, 4.2 to 1.8 for sweet, 4.5 to 2.3 for sour, and 4.7 to 1.2 for bitter during radiotherapy, and was 2.6, 2.6, 2.9, and 2.3, respectively, 1 week after radiotherapy. Three months after treatment, patients’ taste scores began to recover with scores of 4.2, 3.9, 4.1, and 4.0 for salt, sweet, sour, and bitter, respectively. Between 6 months to 1 year, most patients had recovered taste scores.

Partial or complete taste loss was experienced during radiotherapy in 87% of patients for salt, 78% for sweet, 67% for sour, and 88% for bitter. One week after radiotherapy, partial or total taste loss was reported in 57% of patients for salt, 63% for sweet, 58% for sour, and 70% for bitter. At 3 months, 16% of patients had taste loss for salt, 19% for sweet, 16% for sour, and 26% for bitter. At 6 months to 1 year, 7% vs 3% of patients had loss of taste for salt, 4% vs 3% for sweet, 13% vs 3% for sour, and 9% vs 7% for bitter.

The European Organisation for Research and Treatment of Cancer Quality of Life Questionanaire Head and Neck Module (EORTC) highlighted a change of maximal deterioration at time point 2, with a gradual recovery after. At time point 2, patients experienced nausea, vomiting, pain, and appetite loss, but recovered during time points 3 and 4. Patients experienced problems with swallowing, taste or smell, dry mouth, and sticky saliva during timepoints 2 and 3, with slight recovery during timepoints 4 and 5. Patients had the highest scores at 1 week after radiotherapy because no data were available during the treatment when responding to the question, “Have you had problems with your sense of taste?”.

For patients who had a glossectomy, taste dysfunction was experienced in 37.5% of patients compared 6.7% among those who didn’t undergo surgery or 0.0% for radical surgery (RR, 5.63; 95% CI, 1.12-28.15). Oral cavity mean dose was the only variable associated with taste dysfunction (odds ratio [OR], 4.40; 95% CI, 1.45-13.32). If the dose was less than 4000 cGy, 15.6% of patients experienced taste dysfunction vs 44.9% when it was higher than 4000 cGy.For those who underwent a glossectomy and received more than 4000 cGy, patients also experienced taste dysfunction (OR, 12.9; 95% CI, 2.33-71.3).

Reference

Chen WC, Hsu CM, Tsai YT, et al. Prospective evaluation of taste function in patients with head and neck cancer receiving intensity-modulated radiotherapy. JAMA Otolaryngol Head Neck Surg. 2022;148(7):604-611. doi:10.1001/jamaoto.2022.0850