Clinical factors impacting on late dysphagia following radiotherapy in patients with head and neck cancer.

Clinical factors impacting on late dysphagia following radiotherapy in patients with head and neck cancer.

Br J Radiol. 2018 Apr 18;:20180155

Authors: Deschuymer S, Nevens D, Duprez F, Laenen A, Dejaeger E, De Neve W, Goeleven A, Nuyts S

Abstract
OBJECTIVE: Patient and treatment characteristics of patients with head and neck cancer (HNSCC) were correlated with dysphagia scored on swallowing-videofluoroscopy (VFS) and with patient and physician scored dysphagia.
METHODS: Sixty-three HNSCC patients treated with radiotherapy (RT) were evaluated at baseline, 6 and 12 months post-RT. VFS was scored with Penetration Aspiration Scale (PAS) and Swallowing Performance Scale (SPS). Physician and patient scored dysphagia were prospectively recorded according to CTCAE scoring system, RTOG/EORTC scoring system and EORTC-QLQ H&N35 questionnaire.
RESULTS: Univariable analysis revealed a significant association between tumour-subsite and higher SPS (p = 0.02) and patient scored dysphagia (p = 0.02) at baseline. At 12 months, tumour-subsite was significantly associated with higher PAS and SPS. Multivariable analysis and pairwise comparison showed that hypopharyngeal cancer and carcinoma of unknown primary (CUP) were associated with higher SPS at baseline and at 12 months, respectively (p = 0.03 and p = 0.01). Up-front neck dissection (UFND) was significantly associated with higher SPS and physician scored dysphagia in univariable analysis at all timepoints. At 12 months, there was also a significant association with higher PAS (p < 0.01) and patient scored dysphagia (p < 0.01). After multivariable analysis, the association between UFND and higher PAS (p < 0.01) and SPS (p < 0.01) remained significant at 12 months.
CONCLUSION: Hypopharyngeal tumours and CUP were related to more dysphagia at baseline and 12 months, respectively. Furthermore, UFND was associated with more severe dysphagia scored by physicians, patients and on VFS at 12 months. Advances in knowledge: This is the first paper reporting a significant link between UFND and late dysphagia scored with swallowing-videofluoroscopy. We advocate to abandon UFND and preserve neck dissection as salvage option post-RT.

PMID: 29668302 [PubMed - as supplied by publisher]

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