Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer

Journal Article · Sun Feb 01 04:00:00 EST 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.04.048· OSTI ID:21172582

Caudell, Jimmy J; Schaner, Philip E; Meredith, Ruby F ^[1]; Locher, Julie L ^[2]; Nabell, Lisle M ^[3]; Carroll, William R; Magnuson, J Scott ^[4]; Spencer, Sharon A ^[1]

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1. Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL (United States)
2. Department of Medicine, University of Alabama-Birmingham, Birmingham, AL (United States)
3. Department of Medical Oncology, University of Alabama-Birmingham, Birmingham, AL (United States)
4. Department of Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, AL (United States)

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.

• OSTI ID: 21172582
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 2 Vol. 73; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BARIUM
CARCINOMAS
CHEMOTHERAPY
COMBINED THERAPY
DIAGNOSIS
FRACTIONATION
HEAD
MULTIVARIATE ANALYSIS
NECK
ORAL CAVITY
PATIENTS
PNEUMONIA
RADIATION DOSES
RADIATION HAZARDS
RADIOTHERAPY