title: Effect of gabapentin on swallowing during and after chemoradiation for oropharyngeal squamous cell cancer.
abstract: The aim of this study was to examine the impact of gabapentin (neurontin) on swallowing and feeding tube use during chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC), and physiologic swallowing outcomes following completion of treatment. A total of 23 patients treated for OPSCC with concurrent CRT and prophylactically treated for pain using gabapentin were assessed. Historical controls were matched for T stage and primary site of disease. Timing of PEG use and removal were recorded. Video fluoroscopic swallowing studies were completed post-treatment to assess physiologic outcomes as well as penetration-aspiration scores (PAS). Functional oral intake scale (FOIS) scores were determined at the time of swallowing evaluation to assess diet level. Patients treated with gabapentin began using their PEG tubes later (3.7 vs. 2.29 weeks; P = 0.013) and had their PEG tubes removed earlier (7.29 vs. 32.56 weeks; P = 0.039) than the historical controls. A number of physiologic parameters were found to be less impacted in the gabapentin group, including oral bolus control (P = 0.01), epiglottic tilt (P = 0.0007), laryngeal elevation (P = 0.0017), and pharyngeal constriction (P = 0.002). PAS scores were significantly lower in the group treated with gabapentin (1.89 vs. 4; P = 0.0052). Patients receiving gabapentin had more advanced diet levels at the time of the initial swallowing study as evidenced by their FOIS scores (5.4 vs. 3.21; P = 0.0003). We conclude that patients using gabapentin for pain management during CRT appears to do well maintaining swallow function during treatment and have favorable post-treatment physiologic swallowing outcomes. Prospective evaluation is warranted.
authors.affiliation: Johns Hopkins Outpatient Center, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 N. Caroline Street, Suite 6260, Baltimore, MD, 21287, USA, hstarme1@jhmi.edu.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: WuYang
authors.initials: W
authors.lastname: Yang
authors.forename: Raju
authors.initials: R
authors.lastname: Raval
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.forename: Marian
authors.initials: M
authors.lastname: Richardson
authors.forename: Rachit
authors.initials: R
authors.lastname: Kumar
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Jones
authors.forename: Todd
authors.initials: T
authors.lastname: McNutt
authors.forename: Zhi
authors.initials: Z
authors.lastname: Cheng
authors.forename: Sierra
authors.initials: S
authors.lastname: Cheng
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
mesh_terms: D000588:Amines / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D003679:Deglutition / Q000187:drug effects* / Q000502:physiology; D004435:Eating; D004750:Enteral Nutrition; D005260:Female; D000077206:Gabapentin; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin