BACKGROUND: Concurrent chemo irradiation is the standard treatment for patients with head & neck cancer (HNC). Dysphagia is a common late toxicity of treatment. 7-21% of these patients have treatment induced stricture of the upper esophagus causing dysphagia, with a high incidence of the same in cases of carcinoma hypopharynx. The objective of the present study was to identify the incidence of treatment related stricture of the upper esophagus in patients with hypopharyngeal cancer in our institution. METHODS: A retrospective analysis on patients treated for carcinoma hypopharynx, in the department of Radiotherapy at our Institute, between 2008-12 was conducted. All patients who had received chemo irradiation were included Patients who had developed upper esophageal stricture post treatment diagnosed by upper GI endoscopy and required periodic dilatation were analyzed using Fisher's exact test. RESULTS: 377 patients of H&N cancers were evaluated, out of which 15.38 % (58/377) had a hypopharyngeal primary. 51 patients were evaluable for the current analysis (15 females, 36 males; mean age 57yrs); out of which 10 patients developed treatment related stricture in the proximal esophagus (20%) (4 females, 6 males). Post cricoid primary had a higher incidence of stricture (7/10) (p=0.0012** two-tailed), followed by primary of the pyriform sinus (3/10). Posterior pharyngeal wall malignancies did not have treatment induced strictures. The mean interval between completion of treatment and endoscopic diagnosis of stricture was 4 months. 5 out of 10 patients underwent periodic dilatations up to an average of 13mm. CONCLUSIONS: Upper esophageal stricture is an important late effect of chemo irradiation in patients with carcinoma hypopharynx. Post cricoid cancers have a higher incidence of treatment induced strictures.
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