Predictors of Aspiration Pneumonia following Radiotherapy for Head and Neck Cancer

Purkey, Michael T.; Levine, Marc S.; Prendes, Brandon; Norman, M. Frank; Mirza, Natasha

doi:10.1177/000348940911801111

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…Consistent with previous reports [23], hypoalbuminemia was again identified as a factor predictive of aspiration pneumonia after CRT and BRT in our study. The novel predictive factors identified here were poor oral hygiene, use of sleeping pills, coexistence of other malignancies, and habitual alcohol consumption.…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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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“…Rehabilitation of the patient at risk of aspiration is performed by speech‐language therapists using techniques including postural changes in head position during the swallow, swallowing maneuvers designed to close the entrance to the airway early in the swallow, and diet modifications . In typical clinical practice, patients are referred for swallow evaluation only if they present with high‐grade observer‐rated dysphagia . However, in the current study, observer‐rated dysphagia did not predict subsequent AsPn.…”

Section: Discussionmentioning

confidence: 56%

Aspiration pneumonia after chemo–intensity‐modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia‐related predictors

et al. 2013

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Background The purpose of this study was to assess aspiration pneumonia (AsPn) rates and predictors after chemo-irradiation for head and neck cancer. Methods The was a prospective study of 72 patients with stage III to IV oropharyngeal cancer treated definitively with intensity-modulated radiotherapy (IMRT) concurrent with weekly carboplatin and paclitaxel. AsPn was recorded prospectively and dysphagia was evaluated longitudinally through 2 years posttherapy by observer-rated (Common Toxicity Criteria version [CTCAE]) scores, patient-reported scores, and videofluoroscopy. Results Sixteen patients (20%) developed AsPn. Predictive factors included T classification (p = .01), aspiration detected on videofluoroscopy (videofluoroscopy-asp; p = .0007), and patient-reported dysphagia (p = .02–.0003), but not observer-rated dysphagia (p = .4). Combining T classification, patient reported dysphagia, and videofluoroscopy-asp, provided the best predictive model. Conclusion AsPn continues to be an under-reported consequence of chemo-irradiation for head and neck cancer. These data support using patient-reported dysphagia to identify high-risk patients requiring videofluoroscopy evaluation for preventive measures. Reducing videofluoroscopy-asp rates, by reducing swallowing structures radiation doses and by trials reducing treatment intensity in patients predicted to do well, are likely to reduce AsPn rates.

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“…Correlating AIM measures to findings on videofluoroscopy is an important first step; however, it is also important to examine the predictive value of our objective measures in relation to other important clinical outcomes. While it seems intuitive that aspiration on videofluoroscopy should predict clinical sequelae such as pneumonia, the evidence that it does so is in fact poor . Further studies are required to examine the utility of AIM measures to predict clinically relevant outcomes, and to objectively document longitudinal change and over time and following therapy.…”

Section: Discussionmentioning

confidence: 99%

Inter‐rater reliability and validity of automated impedance manometry analysis and fluoroscopy in dysphagic patients after head and neck cancer radiotherapy

Szczesniak

Maclean

Zhang

et al. 2015

Neurogastroenterology Motil

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Predictors of Aspiration Pneumonia following Radiotherapy for Head and Neck Cancer

Cited by 21 publications

References 23 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

Aspiration pneumonia after chemo–intensity‐modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia‐related predictors

Inter‐rater reliability and validity of automated impedance manometry analysis and fluoroscopy in dysphagic patients after head and neck cancer radiotherapy

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