Do Medical Comorbidities Lead to Worse Head and Neck Toxicity for Patients Receiving Radiation Therapy?

Abstract

Purpose/Objective(s)To investigate the influence of medical comorbidities on rates of grade ≥3 acute and chronic toxicities in patients receiving head and neck radiation therapy (RT).Materials/MethodsPatients treated from January 2003 to December 2010 with sequential intensity modulated RT (IMRT) plus or minus concurrent chemotherapy for locally advanced head and neck squamous cell carcinomas were reviewed from a single institution. Medical history, demographics, tumor, and treatment characteristics were collected. Acute and chronic Radiation Therapy Oncology Group toxicities including dermatitis, mucositis, dysphagia, salivary gland function, pain, and weight loss were assessed during treatment and on subsequent follow up visits. Fisher exact test was used to evaluate if any of these factors correlated with grade ≥3 toxicities.ResultsOne hundred and one patients were identified. Median age was 55 years (range, 30-80 y) and median dose 70 Gy (range, 60-75 Gy). Higher rates of grade ≥3 acute dysphagia and salivary gland dysfunction were associated with beta-blocker use (P=.007) and GERD (P=.047), respectively. Higher rates of grade ≥3 chronic skin toxicity and chronic dysphagia were associated with coronary artery disease (P=.036) and greater than 20 pack-year smoking history (P=.029), respectively. Additionally, tumor characteristics including N2-3 disease (P=.004) and Stage IVA-B were associated with higher rates of grade ≥3 chronic salivary gland dysfunction. Higher total doses and BID fractionation to doses greater than 73 Gy correlated with worse chronic skin toxicity (P<.001).ConclusionSeveral medical comorbidities correlate with rates of grade ≥3 acute and chronic toxicities. Evaluating patient comorbidities prior to treatment may be beneficial managing patient’s future expectations of treatment related toxicities. Purpose/Objective(s)To investigate the influence of medical comorbidities on rates of grade ≥3 acute and chronic toxicities in patients receiving head and neck radiation therapy (RT). To investigate the influence of medical comorbidities on rates of grade ≥3 acute and chronic toxicities in patients receiving head and neck radiation therapy (RT). Materials/MethodsPatients treated from January 2003 to December 2010 with sequential intensity modulated RT (IMRT) plus or minus concurrent chemotherapy for locally advanced head and neck squamous cell carcinomas were reviewed from a single institution. Medical history, demographics, tumor, and treatment characteristics were collected. Acute and chronic Radiation Therapy Oncology Group toxicities including dermatitis, mucositis, dysphagia, salivary gland function, pain, and weight loss were assessed during treatment and on subsequent follow up visits. Fisher exact test was used to evaluate if any of these factors correlated with grade ≥3 toxicities. Patients treated from January 2003 to December 2010 with sequential intensity modulated RT (IMRT) plus or minus concurrent chemotherapy for locally advanced head and neck squamous cell carcinomas were reviewed from a single institution. Medical history, demographics, tumor, and treatment characteristics were collected. Acute and chronic Radiation Therapy Oncology Group toxicities including dermatitis, mucositis, dysphagia, salivary gland function, pain, and weight loss were assessed during treatment and on subsequent follow up visits. Fisher exact test was used to evaluate if any of these factors correlated with grade ≥3 toxicities. ResultsOne hundred and one patients were identified. Median age was 55 years (range, 30-80 y) and median dose 70 Gy (range, 60-75 Gy). Higher rates of grade ≥3 acute dysphagia and salivary gland dysfunction were associated with beta-blocker use (P=.007) and GERD (P=.047), respectively. Higher rates of grade ≥3 chronic skin toxicity and chronic dysphagia were associated with coronary artery disease (P=.036) and greater than 20 pack-year smoking history (P=.029), respectively. Additionally, tumor characteristics including N2-3 disease (P=.004) and Stage IVA-B were associated with higher rates of grade ≥3 chronic salivary gland dysfunction. Higher total doses and BID fractionation to doses greater than 73 Gy correlated with worse chronic skin toxicity (P<.001). One hundred and one patients were identified. Median age was 55 years (range, 30-80 y) and median dose 70 Gy (range, 60-75 Gy). Higher rates of grade ≥3 acute dysphagia and salivary gland dysfunction were associated with beta-blocker use (P=.007) and GERD (P=.047), respectively. Higher rates of grade ≥3 chronic skin toxicity and chronic dysphagia were associated with coronary artery disease (P=.036) and greater than 20 pack-year smoking history (P=.029), respectively. Additionally, tumor characteristics including N2-3 disease (P=.004) and Stage IVA-B were associated with higher rates of grade ≥3 chronic salivary gland dysfunction. Higher total doses and BID fractionation to doses greater than 73 Gy correlated with worse chronic skin toxicity (P<.001). ConclusionSeveral medical comorbidities correlate with rates of grade ≥3 acute and chronic toxicities. Evaluating patient comorbidities prior to treatment may be beneficial managing patient’s future expectations of treatment related toxicities. Several medical comorbidities correlate with rates of grade ≥3 acute and chronic toxicities. Evaluating patient comorbidities prior to treatment may be beneficial managing patient’s future expectations of treatment related toxicities.