title: Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors.
abstract: BACKGROUND
  The purpose of this study was to assess aspiration pneumonia (AsPn) rates and predictors after chemo-irradiation for head and neck cancer.
  
  
  METHODS
  The was a prospective study of 72 patients with stage III to IV oropharyngeal cancer treated definitively with intensity-modulated radiotherapy (IMRT) concurrent with weekly carboplatin and paclitaxel. AsPn was recorded prospectively and dysphagia was evaluated longitudinally through 2 years posttherapy by observer-rated (Common Toxicity Criteria version [CTCAE]) scores, patient-reported scores, and videofluoroscopy.
  
  
  RESULTS
  Sixteen patients (20%) developed AsPn. Predictive factors included T classification (p = .01), aspiration detected on videofluoroscopy (videofluoroscopy-asp; p = .0007), and patient-reported dysphagia (p = .02-.0003), but not observer-rated dysphagia (p = .4). Combining T classification, patient reported dysphagia, and videofluoroscopy-asp, provided the best predictive model.
  
  
  CONCLUSIONS
  AsPn continues to be an under-reported consequence of chemo-irradiation for head and neck cancer. These data support using patient-reported dysphagia to identify high-risk patients requiring videofluoroscopy evaluation for preventive measures. Reducing videofluoroscopy-asp rates, by reducing swallowing structures radiation doses and by trials reducing treatment intensity in patients predicted to do well, are likely to reduce AsPn rates.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Klaudia U
authors.initials: KU
authors.lastname: Hunter
authors.forename: Oliver E
authors.initials: OE
authors.lastname: Lee
authors.forename: Teresa H
authors.initials: TH
authors.lastname: Lyden
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Haxer
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.forename: Mathew
authors.initials: M
authors.lastname: Schipper
authors.forename: Francis
authors.initials: F
authors.lastname: Worden
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.forename: Scott A
authors.initials: SA
authors.lastname: McLean
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011015:Pneumonia, Aspiration / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate
keywords: IMRT; aspiration pneumonia; dysphagia; head and neck cancer; oropharyngeal cancer