Persistent Dysphagia after Head and Neck Radiotherapy: A Common and Under-reported Complication with Significant Effect on Non-cancer-related Mortality

Szczesniak, Michal; Maclean, Julia; Zhang, Teng; Graham, PH; Cook, Ian J.

doi:10.1016/j.clon.2014.08.009

Cited by 102 publications

(94 citation statements)

References 34 publications

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“…reported that aspiration pneumonia was a significant prognostic factor. Furthermore, Szczesniak et al [6]. reported that aspiration pneumonia accounted for 19% of non-cancer-related deaths of patients with HNC who received CRT.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with HNC who have undergone definitive CRT tend to have swallowing dysfunction due to mucositis during the treatment period or due to radiation-induced fibrosis of the oropharyngeal musculature after completion of the treatment [5]. Szczesniak et al [6]. reported that approximately 52% of patients who received RT and 69% who received CRT suffered from dysphasia after treatment, and aspiration pneumonia accounted for 19% of non-cancer-related deaths.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study

et al. 2017

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BackgroundChemoradiotherapy (CRT) and bio-radiotherapy (BRT) are recognized as standard therapies for head and neck cancer (HNC). Aspiration pneumonia after CRT or BRT is a common late adverse event. Our aim in this study was to evaluate the cause-specific incidence of aspiration pneumonia after CRT or BRT and to identify its clinical risk factors.MethodsWe performed a retrospective analysis of 305 patients with locally advanced HNC treated by CRT or BRT between August 2006 and April 2015.ResultsOf these 305 patients, 65 (21.3%) developed aspiration pneumonia after treatment. The median onset was 161 days after treatment. The two-year cause-specific cumulative incidence by CRT or BRT was 21.0%. Multivariate analysis revealed five independent risk factors for aspiration pneumonia, namely, habitual alcoholic consumption, use of sleeping pills at the end of treatment, poor oral hygiene, hypoalbuminemia before treatment, and the coexistence of other malignancies. A predictive model using these risk factors and treatment efficacy was constructed, dividing patients into low- (0–2 predictive factors), moderate- (3–4 factors), and high-risk groups (5–6 factors), the two-year cumulative incidences of aspiration pneumonia of which were 3.0, 41.6, and 77.3%, respectively. Aspiration pneumonia tended to be associated with increased risk of death, although this was not statistically significant (multivariate-adjusted hazard ratio 1.39, P = 0.18).ConclusionThe cause-specific incidence and clinical risk factors for aspiration pneumonia after definitive CRT or BRT were investigated in patients with locally advanced HNC. Our predictive model may be useful for identifying patients at high risk for aspiration pneumonia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study

et al. 2017

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“…Results demonstrated that the anterior oral cavity structures and superior pharyngeal constrictor muscles were most at-risk for radiation-induced dysphagia, as indicated by strong association between radiation dose to these critical areas and poor swallowing outcomes as measured by Oropharyngeal Swallowing Efficiency. In contrast, Szczesniak et al [56] found that patient characteristics (i.e., tumor site, therapy, age, gender, or use of chemotherapy) were poor predictors of incidence and severity of late-onset dysphagia. Further work is needed to determine the influence of radiation on the morphology and physiology of structures prominently involved in swallowing and on tissue known to be susceptible to late effects of radiation (i.e., muscle, nerves, and stroma).…”

Section: Temporal Differences In Radiation Injurymentioning

confidence: 98%

“…It is plausible that floor of mouth structures are prone to underlying late-responding tissue changes (i.e., fibrotic, atrophy) that develop over a longer period of time. In cross-sectional analysis, Szczesniak et al [56] examined 226 HNSCC patients 0.5 to 8 years post-radiation to determine prevalence and severity of persistent dysphagia. Of patients with no baseline clinical diagnosis of dysphagia during radiation treatment, 22% self-reported during follow-up evaluation that swallowing problems had arisen after treatment; these patients described various difficulties with clearance of solid foods.…”

Section: Temporal Differences In Radiation Injurymentioning

confidence: 99%

Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer

et al. 2016

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Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia is comprised of a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.

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“…In particular, a recent study has found that longterm, persistent dysphagia is underreported and underrecognized by medical staff with 59% (n ¼ 49/117) of patients reporting impaired swallowing on questionnaire assessment [51]. Of those attending routine follow up appointments, only 47% (n ¼ 27/57) had swallowing status reported in the medical notes.…”

Section: Considerations In Dysphagia Managementmentioning

confidence: 94%

Human papilloma virus-related oropharyngeal cancer

Goldsmith

Roe

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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Clinical trials are now underway to ascertain the effectiveness of tailored treatments for HPV-positive OPC with a focus on swallowing outcomes. It is encouraging that studies are now including detailed, multidimensional swallowing evaluation. Until such time as longitudinal data are available, patients should be treated by speech-language pathologists based on existing radiation treatment protocols and in the knowledge that patients may experience significant late swallowing difficulties.

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Persistent Dysphagia after Head and Neck Radiotherapy: A Common and Under-reported Complication with Significant Effect on Non-cancer-related Mortality

Cited by 102 publications

References 34 publications

Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study

Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study

Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer

Human papilloma virus-related oropharyngeal cancer

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