Persistence of dysphagia and odynophagia after mediastinal radiation and chemotherapy in patients with lung cancer or lymphoma

Abstract

Esophageal symptoms are common during radiation and chemotherapy. It is unclear how often these symptoms persist after therapy. We retrospectively reviewed medical records of 320 adults treated for nonmetastatic breast cancer (84), lung cancer (109), or Hodgkin and non-Hodgkin lymphoma (127) who were disease-free at 10-14 months after therapy. Treatment included chemotherapy with or without nonmediastinal radiation therapy (150 patients), chemotherapy plus sequential mediastinal radiation therapy (MRT) (48 patients), chemotherapy plus concurrent MRT (61 patients), or non-MRT only (61 patients). Proton pump inhibitor use was documented. All treatment groups had similar prevalence of the esophageal symptom of heartburn before therapy. Rates were higher during treatment in those who received MRT with or without chemotherapy, but declined by 10-14 months after treatment. However, low baseline rates of dysphagia (4%) and odynophagia (2%) increased significantly after combined chemotherapy and MRT to 72% for dysphagia and 62% for odynophagia (P < 0.01) during treatment and stayed significantly elevated over baseline with 27% of the patients having dysphagia and 11% having odynophagia at 10-14 months after treatment. The use of proton pump inhibitors by patients who had MRT with chemotherapy was significantly increased during and after treatment (P = 0.002). Dysphagia, odynophagia and the use of proton pump inhibitors were significantly more common both during and after treatment than before treatment in patients who received both chemotherapy and mediastinal radiation. Our data highlight the important challenge for clinicians of managing patients with lung cancer and lymphoma who have persistent esophageal problems, particularly dysphagia and odynophagia, at approximately 1 year after treatment.

Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

“…Other diseases that are associated with heartburn should be considered in patients with refractory GERD. These include achalasia, Zollinger–Ellison syndrome, pill-induced esophagitis, autoimmune skin disease with esophageal manifestations, 96 infectious esophagitis (such as candida and herpes simplex virus), 97 esophageal cancer, 98 nonsteroidal anti-inflammatory drug use, 99 rumination syndrome, 100 radiation-induced esophagitis, 101 and ingestion of caustic agents. 102 The mechanisms of these insults make them unlikely to respond to PPI therapy.…”

Association between physical activity and health-related quality of life: time to deterioration model analysis in lung adenocarcinoma

“…However, physical activity was found to delay the exacerbation of sore mouth in the current study, suggesting that physical activity may be applied as a non-pharmaceutical intervention to improve sore mouth in LUAD patients undergoing chemotherapy. Dysphagia is a persistent symptom in cancer patients after mediastinal radiation and chemotherapy [ 50 ] and has been shown to be associated with a worse prognosis and HRQoL in lung cancer patients [ 51 , 52 ]. Methods to improve dysphagia are an important area of lung cancer therapy research.…”