Risk factors for aspiration pneumonia during concurrent chemoradiotherapy or bio-radiotherapy for head and neck cancer

Shirasu, Hiromichi; Yokota, Tomoya; Fushiki, Kunihiro; Ito, Hiroto; Shibata, Masayuki; Furuta, Mitsuhiro; Kawakami, Takeshi; Kawai, Shinya; Hamauchi, Satoshi; Todaka, Akiko; Tsushima, Takahiro; Machida, Nozomu; Yamazaki, Kentaro; Fukutomi, Akira; Onozawa, Yusuke; Yasui, Hirofumi

doi:10.1093/annonc/mdy287.067

Cited by 3 publications

(7 citation statements)

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“…The low rate of aspiration pneumonia could be attributed, but unable to be confirmed, to the frequent screening for aspiration risk features for all participants which facilitated rapid referral for instrumental assessment and management where warranted. The incidence of aspiration pneumonia falls within the range reported in similar cohorts (5%–25.4%) 44–48 . The large range in published data is likely to be multifactorial, including what type of diagnostic criteria are applied (ICD coding 44,47 or clinical features 46,48 ), the patient cohort studied, and their treatment regime.…”

Section: Discussionsupporting

confidence: 52%

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

et al. 2021

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Background The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration‐related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well‐studied. Method Patient‐ and clinician‐reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Results Ninety‐three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Conclusion Radiation dose to DARS is associated with post‐treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings.

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Section: Discussionsupporting

confidence: 52%

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

et al. 2021

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“…In a retrospective study of 15 894 Taiwanese patients with HNSCC by Chu et al, the authors reported a lower incidence of pneumonia (5%) within 90 days of RT initiation 67 . However, only 15% of the cohort was older than age 65, in contrast to studies with a higher proportions of elderly patients 35,66,67 …”

Section: Introductionmentioning

confidence: 99%

“…Among HNSCC patients, the etiology of aspiration, pneumonia, and pneumonitis is multifactorial and remains an important and often under‐recognized source of morbidity and mortality during and following completion of treatment. In a retrospective analysis of 374 patients who received organ preservation therapy for locally advanced HNSCC, risk factors for aspiration pneumonia included poor oral hygiene, advanced N‐classification, inpatient treatment, and hypoalbuminemia 35 . Treatment breaks occurred far more often in patients with aspiration pneumonia vs those without (36% vs 3%, respectively; P < .01), which ultimately affected survival (Table 1).…”

Section: Introductionmentioning

confidence: 99%

“… 35 Kawai et al reported similar findings and found that 21% (65 of 305) of patients developed pneumonia at a median of 161 days following treatment; chronic alcohol consumption, poor oral hygiene, hypoalbuminemia, coexisting malignancies (mainly esophageal and gastric cancer), and use of sleeping pills were independent predictors 66 . Rates of post‐treatment pneumonia range from 5% to 25%, with concurrent CRT having the largest influence on its development in most studies 5,6,35,66‐72 . The sequela can be devastating with 30‐day mortality rates of 20% to 30% 24,73‐75 .…”

Section: Introductionmentioning

confidence: 99%

“…Decrease in mortality may be associated with decreased pneumonia incidence and severity as well as the oncologic benefits conferred through routine dental and oral cavity surveillance 81‐83 . This further underscores the importance of maintaining a healthy oral cavity, particularly in older patients and those with previously treated HNSCC 35,66,84 . In all, increased attention should be paid to modifiable risk factors including smoking, oral hygiene, and nutrition status in order to mitigate aspiration risks.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory and pulmonary complications in head and neck cancer patients: Evidence‐based review for the COVID‐19 era

et al. 2020

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Background: Pulmonary complications and infections frequently affect patients with head and neck squamous cell carcinoma (HNSCC). Common characteristics can predispose these patients to the development of severe respiratory illness, which may be particularly relevant during the 2019 coronavirus disease (COVID-19) pandemic. Methods: A scoping review was performed to assess the impact of pulmonary comorbidities and adverse respiratory outcomes in HNSCC patients. Results: Advanced age, history of tobacco and alcohol abuse, and cardiopulmonary comorbidities are significant risk factors for the development of adverse respiratory outcomes. Treatment toxicities from radiation or chemoradiation therapy significantly increase these risks.Conclusion: Respiratory complications are a frequent cause of morbidity and mortality among HNSCC patients, and the COVID-19 pandemic may disproportionately affect this population. Interventions designed to decrease smoking and alcohol use, improve oral hygiene, and aggressively manage medical comorbidities are important to the long-term management and health of these patients. K E Y W O R D Sadverse respiratory outcomes, COVID-19, head and neck squamous cell carcinoma (HNSCC), pulmonary comorbidities, respiratory infections and complications

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Risk factors for rebleeding and long-term outcomes in patients with head and neck cancer bleeding: a multicenter study

Wang

Niu

et al. 2022

BMC Cancer

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Background Acute, catastrophic bleeding in patients with head and neck cancer (HNC) is challenging and also a burden for their families and frontline physicians. This study analyzed the risk factors for rebleeding and long-term outcomes in these patients with HNC. Methods Patients who presented to the emergency department (ED) with HNC bleeding were enrolled in this study (N = 231). Variables of patients with or without rebleeding were compared, and associated factors were investigated using Cox’s proportional hazard model. Results Of the 231 patients enrolled, 112 (48.5%) experienced a recurrent bleeding event. The cumulative rebleeding incidence rate was 23% at 30 days, 49% at 180 days, and 56% at 1 year. Multivariate Cox regression analyses demonstrated that overweight-to-obesity (HR = 0.52, 95% CI 0.28–0.98, p = 0.043), laryngeal cancer (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.07–4.23, p = 0.031), chemoradiation (HR = 1.49, 95% CI 1.001–2.94, p = 0.049), and second primary cancer (HR = 1.75, 95% CI 1.13–2.70, p = 0.012) are significant independent predictors of rebleeding, and the prognostic factors for overall survival included underweight (HR = 1.89, 95% CI 1.22–2.93, p = 0.004), heart rate > 110 beats/min (HR = 1.58, 95% CI 1.04–2.39, p = 0.032), chemoradiation (HR = 2.31, 95% CI 1.18–4.52, p = 0.015), and local recurrence (HR = 1.74, 95% CI 1.14–2.67, p = 0.011). Conclusions Overweight-to-obesity is a protective factor, while laryngeal cancer, chemoradiation and a second primary cancer are risk factors for rebleeding in patients with HNC. Our results may assist physicians in risk stratification of patients with HNC bleeding.

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Risk factors for aspiration pneumonia during concurrent chemoradiotherapy or bio-radiotherapy for head and neck cancer

Cited by 3 publications

References 0 publications

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

Respiratory and pulmonary complications in head and neck cancer patients: Evidence‐based review for the COVID‐19 era

Risk factors for rebleeding and long-term outcomes in patients with head and neck cancer bleeding: a multicenter study

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