Long‐term functional and survival outcomes after induction chemotherapy and risk‐based definitive therapy for locally advanced squamous cell carcinoma of the head and neck

Abstract

Purpose To evaluate long-term outcomes after induction chemotherapy followed by “risk-based” local therapy for squamous cell carcinoma of the head and neck (SCCHN). Methods Forty-seven patients (stage IV, ≥N2b) were enrolled in a Phase II trial. Baseline and 24-months functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. Results Five-year overall survival was 89% (95% CI: 81%-99%). A non-significant 13% average reduction in swallowing efficiency (OPSE) was observed at 24-months relative to baseline (p=0.191). MDADI scores approximated baseline at 24-months. Among 42 long-term survivors (median=5.9 years), 3 (7.1%) had chronic dysphagia. The rate of final gastrostomy-dependence was 4.8% (2/42). Conclusion Sequential chemoradiotherapy achieved favorable outcomes among patients with locally-advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors.

Beyond mean pharyngeal constrictor dose for beam path toxicity in non-target swallowing muscles: Dose–volume correlates of chronic radiation-associated dysphagia (RAD) after oropharyngeal intensity modulated radiotherapy

“…Given the longitudinal, retrospective nature of this study, the potential for underreporting is also of concern. However, it should be noted that median follow-up was 48 months, and 94% of patients were followed for more than two years and though videoflouroscopy was not used routinely creating the potential for missed “silent aspiration,” the 7% rate of chronic aspiration detected by videoflouroscopy in the current study is very close to the 7.6% aspiration rate we previously reported for a group of patients in a prospective institutional organ preservation trial using routine videoflouroscopic dysphagia assessment[33]. Finally, our choice of recursive partitioning analytic methods represents an inherently “greedy” model system, and classification and regression tree approaches often are sensitive to “noise” from random variation within the dataset.…”

“…Even in modern practice, up to 60% of patients require feeding tube placement during IMRT[42]. More alarmingly, we previously reported a 7.6% chronic aspiration rate amongst head and neck (primarily oropharyngeal) squamous cell carcinoma patients undergoing chemoradiotherapy[33], and the Michigan group have reported that up to 20% of survivors develop chronic aspiration even with dysphagia-optimized IMRT planned specifically to minimize dose to non-target swallow critical structures including the constrictors and larynx[43–45]. …”

“…The wide array of candidate dysphagia-associated structures implicated by our group and others in previous studies reflects the complicated nature of RAD and suggests that further insight into its mechanism could be helpful in preparing future treatment regimens. To this end, as part of an ongoing HNC toxicity reduction program[19–33], specific aims of our study include:…”

RETRACTED: Laryngeal Function After Radiation Therapy

“…[18][19][20] Indeed, it is often the treatment of choice for laryngeal cancers because the functional outcomes are good and seem superior to surgical management. 21,22 Although oncologically effective, radiation to the vocal folds can be associated with functional limitations.…”

Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer

“…These exercise programs are associated with better post-treatment swallowing function, in particular on the short-term [5][6][7][8][9][10], and probably also longer-term [11]. However, since dysphagia can develop and/or progress years after CRT [12,13], long term (10-years+) prospectively collected swallowing and mouth opening data are of great importance to assess deglutition in HNC survivors [14]. In this study the prospectively collected objective and subjective functional results at 10-years+ post-treatment will be reported in a patient cohort treated with CRT for advanced, anatomical and functional inoperable HNC.…”