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

Abstract

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.

• Authors: Klaudia U Hunter, Oliver E Lee, Teresa H Lyden, Marc J Haxer, Felix Y Feng, Mathew Schipper, Francis Worden, Mark E Prince, Scott A McLean, Gregory T Wolf, Carol R Bradford, Douglas B Chepeha, Avraham Eisbruch
• Journal: Head & neck (Head Neck) Vol. 36 Issue 1 Pg. 120-5 (Jan 2014) ISSN: 1097-0347 [Electronic] United States
• PMID: 23729173 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Wiley Periodicals, Inc.

Topics

• Adult
• Aged
• Biopsy, Needle
• Chemoradiotherapy (adverse effects, methods)
• Cohort Studies
• Deglutition Disorders (epidemiology, etiology, physiopathology)
• Female
• Follow-Up Studies
• Humans
• Immunohistochemistry
• Incidence
• Longitudinal Studies
• Male
• Middle Aged
• Multivariate Analysis
• Observer Variation
• Oropharyngeal Neoplasms (mortality, pathology, therapy)
• Pneumonia, Aspiration (epidemiology, etiology, physiopathology)
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Risk Assessment
• Survival Rate