Oncology News Updates
Long-Term Dysphagia Common in Head and Neck Cancer Patients
Elsevier Global Medical News
Aug 22, 2008
Almost 40% of patients who underwent definitive radiotherapy for cancers of the head and neck experienced long-term dysphagia, according to a retrospective study of 122 patients.
Furthermore, patients who underwent concurrent chemotherapy in addition to radiotherapy were almost nine times as likely to experience long-term dysphagia as those who underwent radiotherapy alone.
The study, conducted by Jimmy J. Caudell, Ph.D., and colleagues from the University of Alabama, Birmingham, was presented in a poster session at the Seventh International Conference on Head and Neck Cancer.
All patients in the study had squamous cell carcinoma of the head and neck, were treated between 2001 and 2006, and were followed for up to 36 months. Investigators judged them to have long-term dysphagia if they had any one of three signs: long-term dependence on a feeding tube, aspiration as seen on a modified barium swallow along with a diagnosis of aspiration pneumonia, or pharyngoesophageal stricture with the subsequent need for dilation.
Of the 122 patients, 38.5% experienced one of those signs, 13.1% experienced two, and 4.1% experienced all three. A total of 45 of the 47 patients with dysphagia underwent concurrent chemotherapy. In a multivariate analysis that adjusted for potential confounders, investigators found that patients who underwent concurrent chemotherapy were 8.9 times more likely to develop long-term dysphagia than those who did not.
Two additional factors emerged as statistically significant predictors of long-term dysphagia in the multivariate analysis. Patients who were 55 years old or older were 5% more likely to have long-term dysphagia than those who were younger. And patients whose primary cancers were in the larynx, hypopharynx, base of tongue, or pharyngeal wall were 2.7 times as likely to develop long-term dysphagia as those whose primary cancers were in the tonsil, soft palate, oral cavity, nasal cavity, or nasopharynx.
Before the initiation of radiotherapy, 89.4% of the patients had percutaneous endoscopic gastrostomy (PEG) tubes placed. In the group as a whole, PEG tubes were removed in a median of 8 months, but at the final follow-up, 13.9% of patients remained dependent on the PEG tube for all or a portion of their nutrition. Investigators found evidence of aspiration in 24.6% of the patients, and they found pharyngoesophageal strictures or stenosis requiring dilation in 17.2%.
The investigators suggested that it would be worthwhile to explore various strategies in the hope of avoiding dysphagia in patients undergoing radiotherapy for head and neck cancer. In particular, they mentioned three such strategies: early intervention with swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated radiotherapy to avoid targeting uninvolved swallowing structures.
Return to Oncology News Updates