Analysis of factors influencing aspiration risk following chemoradiation for oropharyngeal cancer

Abstract

Our aim was to identify risk factors for aspiration following concurrent chemoradiation for oropharyngeal cancer. 46 patients with locally advanced oropharyngeal carcinoma underwent concurrent chemoradiation at our institution. All patients underwent modified barium swallow to assess dysphagia severity and to determine the need for continued tube feedings after treatment. Dysphagia severity was graded as 1-7. There were 5 Grade 2, 11 Grade 3, 5 Grade 4, 5 Grade 5, 10 Grade 6 and 10 Grade 7 scores. 25 patients (54%) developed aspiration (5 trace, 20 severe). The aspiration rate for T1-T2 and T3-T4 tumours was 31% and 67%, respectively (p = 0.03). There was no statistical difference in the aspiration rate between the base of the tongue and tonsillar carcinoma (p = 0.23). Despite anatomical organ preservation, most patients with locally advanced oropharyngeal carcinoma had moderate to severe dysphagia after chemoradiation. Patients with large tumours had a significant risk of developing aspiration following treatment.

A Randomized Prospective Study of Rehabilitation Therapy in the Treatment of Radiation-induced Dysphagia and Trismus

“…Patients with head and neck cancer often develop dysphagia after chemoradiation and postoperative radiation due to injury to the brain stem or the lower cranial nerves [2,13,20]. In addition, radiation may reduce the blood supply to the tissues around the temporomandibular joint and result in fibrosis [26].…”

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

“…Some physicians advocate for prophylactic PEG tube placement (i.e., placement before treatment begins) [39][40][41], especially for patients with locally advanced stages of disease. Benefits to prophylactic PEG tube placement in HNC patients undergoing radiotherapy or chemoradiotherapy include decreased weight loss [24,42,43], fewer hospital admissions [21,44], lower rates of dehydration [21,22,24], fewer treatment breaks due to acute radiationrelated toxicities [45], and lower medical costs [46].…”

Oncologic and Functional Outcomes of Surgical and Nonsurgical Treatment of Advanced Squamous Cell Carcinoma of the Supraglottic Larynx

“…4,8,[14][15][16] Organ-sparing treatment is also associated with significant toxic effects, some of which have been suggested to contribute to the high number of late noncancer deaths noted in patients treated nonsurgically. 9, [17][18][19] Moreover, whether anatomic larynx preservation translates to superior voice outcomes in the long term remains to be shown. Consequently, it has been argued that larynx preservation is not worthwhile if survival is compromised, there is no actual functional advantage, or patients succumb to late toxic effects that are attributable to the larynxpreserving treatment.…”