title: Risk factors for severe Dysphagia after concurrent chemoradiotherapy for head and neck cancers.
abstract: OBJECTIVE
  The aim of this study was to investigate the risk factors for dysphagia induced by chemoradiotherapy for head and neck cancers.
  
  
  METHODS
  Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy from December 1998 to March 2006 were reviewed retrospectively. Median age was 63 years (range, 16-81). The locations of the primary lesion were as follows: larynx in 18 patients, oropharynx in 11, nasopharynx in 7, hypopharynx in 7 and others in 4. Clinical stages were as follows: Stage II in 20 and Stages III-IV in 27. Almost all patients underwent platinum-based concomitant chemoradiotherapy. The median cumulative dose of cisplatin was 100 mg/m(2) (range, 80-300) and median radiation dose was 70 Gy (range, 50-70).
  
  
  RESULTS
  Severe dysphagia (Grade 3-4) was observed in 22 patients (47%) as an acute toxic event. One patient required tube feeding even at 12-month follow-up. In univariate analysis, clinical stage (III-IV) (P = 0.017), primary site (oro-hypopharynx) (P = 0.041) and radiation portal size (>11 cm) (P < 0.001) were found to be associated with severe dysphagia. In multivariate analysis, only radiation portal size was found to have a significant relationship with severe dysphagia (P = 0.048).
  
  
  CONCLUSIONS
  Larger radiation portal field was associated with severe dysphagia induced by chemoradiotherapy.
authors.affiliation: Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. kkoiwai@shinshu-u.ac.jp
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Koiwai
authors.forename: Naoto
authors.initials: N
authors.lastname: Shikama
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sasaki
authors.forename: Atsunori
authors.initials: A
authors.lastname: Shinoda
authors.forename: Masumi
authors.initials: M
authors.lastname: Kadoya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002945:Cisplatin; D005472:Fluorouracil