title: Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation.
abstract: BACKGROUND
  Concurrent chemoradiation therapy has been demonstrated to be effective as an organ-sparing treatment for select advanced head and neck squamous cell carcinoma (HNSCC). However, this treatment modality is not without side effects. One side effect is the formation of upper esophageal strictures. As concurrent chemoradiation treatment is used more frequently, it is important to identify risk factors associated with stricture formation.
  
  
  METHODS
  A retrospective chart review of all patients who had undergone definitive concurrent chemoradiation treatment between 1989 and 2002 was performed. Exclusion criteria included death within 1 year or persistent/recurrent disease that required surgical salvage at the primary site. The outcome measure was stricture formation as determined by both objective findings (barium swallow or endoscopy) and the need for dilation after treatment.
  
  
  RESULTS
  Of the 222 patients in this cohort, there were enough data for 199 patients to assess for stricture formation. Strictures developed in a total of 41 patients (21%). Significant predictive factors were a twice-daily (BID) radiation fractionation (p = .007), female sex (p = .015), and a hypopharyngeal primary site (p = .01). Age and tumor extent were not significant factors in stricture formation (p = .15 and p = .23, respectively).
  
  
  CONCLUSIONS
  Symptomatic strictures occur in 21% of patients undergoing concurrent chemoradiation for HNSCC. Female sex, BID radiation fractionation, and a hypopharyngeal primary site are significant predictive factors for stricture formation.
authors.affiliation: Head and Neck Institute, Cleveland Clinic Foundation, Ohio Desk A71, 9500 Euclid Ave., Cleveland, Ohio 44195, USA. leew@ccf.org
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.forename: Jerrod P
authors.initials: JP
authors.lastname: Saxton
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Wood
authors.forename: Marshall
authors.initials: M
authors.lastname: Strome
authors.forename: Robert S
authors.initials: RS
authors.lastname: Butler
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Esclamado
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007013:Hypopharynx / Q000473:pathology* / Q000528:radiation effects; D008297:Male; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects