Aspiration pneumonia in patients treated with radiotherapy for head and neck cancer

Abstract

Aspiration and aspiration pneumonia has been reported with a high incidence in head and neck cancer populations treated with chemo-radiotherapy. The aim of this study was to investigate the incidence and mortality of aspiration pneumonia in an unselected series of head and neck cancer patients treated with curative radiotherapy with or without concurrent weekly cisplatin. Material and methods. A total of 324 consecutive patients treated with curative intended radiotherapy for head and neck cancer in a single Danish referral center in Aarhus from 2006 to 2008 were included and followed for a median of 4.3 years. Data on patient, tumor and treatment characteristics were obtained from the DAHANCA database. Data on hospital admissions were obtained from the National Patient Registry. Data from the National Registry of Causes of Death were obtained on all deaths and causes of death. Results. Severe dysphagia occurred in 32% of the 324 patients included. A total of 18 patients developed aspiration pneumonia, corresponding to an incidence rate of 29 (95% CI 17-46) per 1000 person-years and an incidence proportion of 5.3% (95% CI 3.1-8.3%) in the fi rst year after radiotherapy; signifi cant risk factors included tube feeding, clinical stage, severe dysphagia and incomplete response to treatment. Three of the 18 patients with aspiration pneumonia died from this complication. Conclusion. Dysphagia-related aspiration and aspiration pneumonia are serious and potentially fatal treatment complications to accelerated radiotherapy, but occur less frequent than previously reported.

Risk factors for aspiration pneumonia after definitive chemoradiotherapy or bio-radiotherapy for locally advanced head and neck cancer: a monocentric case control study

“…First, it involved a retrospective analysis at a single institution. Second, differential diagnosis between aspiration pneumonia and other types of pneumonia was often difficult because the definitions of aspiration pneumonia varied among previous reports [9–11]. Third, the median follow-up of 2.4 years was shorter than in previous studies [4, 7].…”

“…Several risk factors for aspiration pneumonia in patients with HNC after CRT were reported in previous studies [7, 9, 17]. However, evaluation of the long-term risk factors was often difficult in patients with HNC because these patients’ characteristics varied according to the multimodal therapies that they had received, including surgery, CRT, and RT.…”

“…Although approximately 60–70% of patients with HNC treated with CRT suffer from dysphagia or aspiration as a late toxicity [16, 17], in previous studies, the incidence of aspiration pneumonia within a year after CRT was found to differ, ranging from 5.4 to 23% [9, 17, 18]. Furthermore, no differences in the frequency of aspiration pneumonia were seen between the different observation periods, despite the improvement of radiation techniques and general management of CRT over the time.…”

“…Because it is sometimes difficult to clearly distinguish aspiration pneumonia from other types of pneumonia, different definitions of aspiration pneumonia were used in previous studies [9–11]. Therefore, in this study, we defined aspiration pneumonia as a clinical condition that met all of the following criteria: (i) Patients had both subjective and objective symptoms suggesting pneumonia.…”

Risk of swallowing‐related chest infections in patients with nasopharyngeal carcinoma treated with definitive intensity‐modulated radiotherapy

“…Additionally, information on the prevalence of aspiration pneumonia among postirradiated patients with NPC is limited. Much of this information is derived from postirradiated head and neck squamous cell cancer from other subsites, which reports a prevalence of 5.6% and 20% . This prevalence rate cannot be assumed in patients with NPC because the radiation fields are dissimilar.…”