Swallowing Function in Patients With Head and Neck Cancer Prior to Treatment

Stenson, Kerstin; MacCracken, Ellen; List, Marcy A.; Haraf, Daniel J.; Brockstein, Bruce; Weichselbaum, Ralph; Vokes, Everett E.

doi:10.1001/archotol.126.3.371

Cited by 147 publications

(109 citation statements)

References 22 publications

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“…3,4,20 Nevertheless, from retrospective reviews, it appears that the long-term rate of feeding tube requirement is similar, 17,19 with the notable exception of the study by Fein et al, 14 who reported on 490 patients treated with radiotherapy alone for oropharyngeal primary tumors and noted permanent gastrostomy tubes in only two patients. In our cohort, similar to reports by other groups, [24][25][26] patients with hypopharyngeal and laryngeal primary tumors were at greatest risk for swallowing dysfunction after CRT. These patients may benefit from intensive swallowing and physical therapy before, during, and after treatment.…”

Section: Discussionsupporting

confidence: 90%

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

Cohen

Haraf

List

et al. 2006

JCO

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Purpose-Patients with intermediate-stage squamous cell carcinoma of the head and neck traditionally have been treated with initial surgical resection followed by radiotherapy (RT) alone or chemoradiotherapy. A previous study in this patient population reported a 91% locoregional control rate and 65% overall survival (OS) rate at 5 years, with chemoradiotherapy used as primary treatment. This study was undertaken to assess whether shortening treatment duration with hyperfractionated RT would be feasible and improve locoregional control, organ preservation, and progression-free survival. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMethods-Eligible patients with stage II or III disease received fluorouracil, hydroxyurea, and RT given twice daily on a week-on/week-off schedule. Quality-of-life scores were measured using three validated indexes.Results-All 53 patients enrolled are included in the analysis, with a median follow-up of 42 months (range, 5 to 98 months). Grade 3 or 4 in-field mucositis was observed in 77% and 9%, respectively. No patients required surgical salvage at the primary tumor site (pathological complete response rate, 100%). The 3-year progression-free and OS rates are 67% and 78%, respectively. The 3-year disease-specific mortality rate is 7%. At the time of analysis, 87% of surviving patients do not require enteral feeding support. Quality-of-life and performance assessment indicated that, although acute treatment toxicities were severe, most patients returned to pretreatment function by 12 months.Conclusion-Concurrent chemoradiotherapy with hyperfractionated RT is feasible in this patient population and yields high local control and cure rates. Compared with our historical control using once-daily fractionation, hyperfractionation is accompanied by increased acute infield toxicity.

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Section: Discussionsupporting

confidence: 90%

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

Cohen

Haraf

List

et al. 2006

JCO

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“…In addition, symptomatic or asymptomatic aspiration may be present. 41 The degree of impairment depends on the anatomic location of the tumor. Laryngeal and hypopharyngeal carcinomas are severely affected compared with other sites.…”

Section: Combined Therapy For Head and Neck Malignancies/nguyen Et Almentioning

confidence: 99%

Combined chemotherapy and radiation therapy for head and neck malignancies

Nguyen

Sallah

Karlsson

et al. 2002

Cancer

197

167

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Acute side effects of combined chemotherapy and radiation therapy usually were found to resolve after treatment. Long-term morbidity is substantial because of xerostomia and severe dysphagia. However, preliminary studies suggest that because of organ preservation, patients may achieve a better quality of life after chemoradiation compared with the conventional use of surgery and postoperative radiation.

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“…In present study majority (34.89 %) of patients with aspiration had laryngeal cancer followed by tongue cancer (22.14 %). In contrast, Stenson et al [12] reported that the incidence rate of aspiration reaches 30, 67, and 80 % in patients with oral, laryngeal, and pharyngeal head and neck cancers respectively, whereas Starmer et al [13] reported that head and neck cancer involving the larynx or the hypopharynx is a principal risk factor for aspiration. Eischbruch et al [1] reported that though swallowing-related structures were normal, radio therapy and chemotherapy affects movement of the oral cavity and laryngopharyngeal musculature and, thus, causes aspiration.…”

Section: Discussionmentioning

confidence: 95%

“…The destruction of normal tissues by head-and-neck malignancies, surgery, inflammation, and/or radiation-induced fibrosis of the pharyngeal muscles are potential mechanisms responsible for dysphagia in head-and-neck cancer patients [8]. When aspiration occurs because of compromise of the swallowing reflex, pneumonia and respiratory failure may lead to death [1].…”

Section: Discussionmentioning

confidence: 99%

Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern

Lakshmaiah

Sirsath

Subramanyam

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Most patients with head and neck cancer have dysphagia and are at increased risk of having aspiration and subsequent pneumonia. It can cause prolonged hospitalization, treatment delay and/or interruption and mortality in cancer patients. The treatment of these infections often relies on empirical antibiotics based on local microbiology and antibiotic sensitivity patterns. The aim of present study is to analyse respiratory tract pathogens isolated by sputum culture in head and neck cancer patients undergoing treatment at a tertiary cancer centre in South India who presented with features of aspiration. The study is carried out to establish empirical antibiotic policy for head and neck cancer patients who present with features of aspiration. This was a retrospective study. The study included sputum samples sent for culture and sensitivity from January 2011 to December 2012. Analysis of microbiologic species isolated in sputum specimen and the antibiotic sensitivity pattern of the bacterial isolates was performed. A detailed study of case files of all patients was done to find out which is the most common site prone for producing aspiration. There were 47 (31.54 %) gram positive isolates and 102 (68.45 %) gram negative isolates. The most common bacterial isolates were Klebsiella pneumoniae (25.50 %), Pseudomonas aeruginosa (16.77 %) and Haemophilus influenzae (15.43 %). Levofloxacin was the most effective antibiotic with excellent activity against both gram positive and gram negative isolates. Most patients with aspiration had laryngeal cancer (34.89 %). Aspiration pneumonia was present in 14 (9.39 %) patients. Gram negative bacteria are common etiologic agents in head and neck cancer patients presenting with features of aspiration. Levofloxacin should be started as empirical antibiotic in these patients while awaiting sputum culture sensitivity report. As aspiration in head and neck cancer is an underreported event such institutional antibiotic sensitivity studies should be encouraged for prompt initiation of antibiotic that is most likely to be effective against etiologic pathogens.

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Swallowing Function in Patients With Head and Neck Cancer Prior to Treatment

Cited by 147 publications

References 22 publications

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

High Survival and Organ Function Rates After Primary Chemoradiotherapy for Intermediate-Stage Squamous Cell Carcinoma of the Head and Neck Treated in a Multicenter Phase II Trial

Combined chemotherapy and radiation therapy for head and neck malignancies

Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern

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