title: Persistence of dysphagia and odynophagia after mediastinal radiation and chemotherapy in patients with lung cancer or lymphoma.
abstract: Esophageal symptoms are common during radiation and chemotherapy. It is unclear how often these symptoms persist after therapy. We retrospectively reviewed medical records of 320 adults treated for nonmetastatic breast cancer (84), lung cancer (109), or Hodgkin and non-Hodgkin lymphoma (127) who were disease-free at 10-14 months after therapy. Treatment included chemotherapy with or without nonmediastinal radiation therapy (150 patients), chemotherapy plus sequential mediastinal radiation therapy (MRT) (48 patients), chemotherapy plus concurrent MRT (61 patients), or non-MRT only (61 patients). Proton pump inhibitor use was documented. All treatment groups had similar prevalence of the esophageal symptom of heartburn before therapy. Rates were higher during treatment in those who received MRT with or without chemotherapy, but declined by 10-14 months after treatment. However, low baseline rates of dysphagia (4%) and odynophagia (2%) increased significantly after combined chemotherapy and MRT to 72% for dysphagia and 62% for odynophagia (P < 0.01) during treatment and stayed significantly elevated over baseline with 27% of the patients having dysphagia and 11% having odynophagia at 10-14 months after treatment. The use of proton pump inhibitors by patients who had MRT with chemotherapy was significantly increased during and after treatment (P = 0.002). Dysphagia, odynophagia and the use of proton pump inhibitors were significantly more common both during and after treatment than before treatment in patients who received both chemotherapy and mediastinal radiation. Our data highlight the important challenge for clinicians of managing patients with lung cancer and lymphoma who have persistent esophageal problems, particularly dysphagia and odynophagia, at approximately 1 year after treatment.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Shields
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Evaluation, Harvard Medical School, Boston, MA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pelletier
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Freedman
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Mamon
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ng
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Freedman
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Come
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Avigan
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Huberman
authors.affiliation: Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Abram
authors.initials: A
authors.lastname: Recht
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006356:Heartburn / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D000069451:Long Term Adverse Effects / Q000453:epidemiology / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications / Q000628:therapy; D008223:Lymphoma / Q000150:complications / Q000628:therapy; D008297:Male; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D011832:Radiation Injuries / Q000150:complications* / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D054328:Proton Pump Inhibitors
keywords: chemotherapy; dysphagia; heartburn; mediastinal radiation therapy; odynophagia