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


CONCLUSIONS
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.
Caudell
Jimmy J
JJ
Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, USA.
Schaner
Philip E
PE
Meredith
Ruby F
RF
Locher
Julie L
JL
Nabell
Lisle M
LM
Carroll
William R
WR
Magnuson
J Scott
JS
Spencer
Sharon A
SA
Bonner
James A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D004940:Esophageal Stenosis / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000209:etiology; D011015:Pneumonia, Aspiration / Q000175:diagnosis; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D047368:Tumor Burden; D055815:Young Adult