title: Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer.
abstract: OBJECTIVE
  To assess toxicities, functional outcomes, and health-related quality of life associated with concurrent chemoradiation therapy (CRT) in patients with head and neck cancer.
  
  
  METHODS
  Prospective and retrospective outcomes study.
  
  
  METHODS
  Tertiary care institution.
  
  
  METHODS
  Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1, 2000, and March 1, 2007 (n = 104).
  
  
  METHODS
  Patients prospectively provided functional and health-related quality of life information, including data from the 1-year and most current follow-up visits. Medical records were reviewed to determine toxicity and survival rates.
  
  
  METHODS
  Well-defined acute and late toxicities; functional outcomes (diet, dentition, tracheostomies); head and neck cancer-specific, general health, and depression outcomes; and survival rates.
  
  
  RESULTS
  Most patients had oropharyngeal or laryngeal tumors (87.5%) and advanced-stage disease (75.0%). Approximately one-half had hematologic toxicities and toxicity-related treatment delays. Approximately one-quarter had neurotoxicities and/or ototoxicites, moist desquamation, pneumonia, nausea and vomiting requiring hospitalization or intravenous fluids, dehydration or malnutrition requiring hospitalization, and mild or moderate fever. Although patients receiving the current intensity-modulated radiation therapy (IMRT) protocol using the Pinnacle(3) planning system had more toxicity-related treatment delays, they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system.
  
  
  CONCLUSIONS
  Patients receiving CRT experience a substantial number of treatment-related adverse events, primarily affecting oropharyngeal and laryngeal function, with improvement noted for the current IMRT protocol. Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Givens
authors.forename: Lucy Hynds
authors.initials: LH
authors.lastname: Karnell
authors.forename: Anjali K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Clamon
authors.forename: Nitin A
authors.initials: NA
authors.lastname: Pagedar
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Chang
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Van Daele
authors.forename: Gerry F
authors.initials: GF
authors.lastname: Funk
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents