Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer.

Academic Article

Abstract

  • PURPOSE: The use of altered fractionation radiotherapy (RT) regimens, as well as concomitant chemotherapy and RT, to intensify therapy for locally advanced head-and-neck cancer can lead to increased rates of long-term dysphagia. METHODS AND MATERIALS: We identified 122 patients who had undergone definitive RT for locally advanced head-and-neck cancer, after excluding those who had been treated for a second or recurrent head-and-neck primary, had Stage I-II disease, developed locoregional recurrence, had <12 months of follow-up, or had undergone postoperative RT. The patient, tumor, and treatment factors were correlated with a composite of 3 objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy tube dependence at the last follow-up visit; aspiration on a modified barium swallow study or a clinical diagnosis of aspiration pneumonia; or the presence of a pharyngoesophageal stricture. RESULTS: A composite dysphagia outcome occurred in 38.5% of patients. On univariate analysis, the primary site (p = 0.01), use of concurrent chemotherapy (p = 0.01), RT schedule (p = 0.02), and increasing age (p = 0.04) were significantly associated with development of composite long-term dysphagia. The use of concurrent chemotherapy (p = 0.01), primary site (p = 0.02), and increasing age (p = 0.02) remained significant on multivariate analysis. CONCLUSION: The addition of concurrent chemotherapy to RT for locally advanced head-and-neck cancer resulted in increased long-term dysphagia. Early intervention using swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated RT to reduce the dose to the uninvolved swallowing structures should be explored further in populations at greater risk of long-term dysphagia.
  • Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Squamous Cell, Combined Modality Therapy, Constriction, Pathologic, Deglutition Disorders, Esophageal Stenosis, Female, Gastrostomy, Head and Neck Neoplasms, Humans, Male, Middle Aged, Pharyngeal Diseases, Pneumonia, Aspiration, Radiotherapy Dosage, Regression Analysis, Tumor Burden, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Caudell JJ; Schaner PE; Meredith RF; Locher JL; Nabell LM; Carroll WR; Magnuson JS; Spencer SA; Bonner JA
  • Start Page

  • 410
  • End Page

  • 415
  • Volume

  • 73
  • Issue

  • 2