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

Sadayuki Kawai,Takahiro Tsushima,Tomoya Yokota,Hirofumi Yasui,Takashi Yurikusa,Hirofumi Ogawa,Yukio Yoshida,Tsuyoshi Onoe,Tetsuro Onitsuka,Satoshi Hamauchi,Yusuke Onozawa,Keita Mori,Akiko Todaka,Akira Fukutomi,Yosuke Kito

doi:10.1186/s12885-017-3052-8

Sadayuki Kawai, Takahiro Tsushima + Show 13 more

Open Access

https://doi.org/10.1186/s12885-017-3052-8

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Journal: BMC Cancer	Publication Date: Jan 17, 2017
Citations: 30	License type: open-access

Affiliation: Shizuoka Cancer Center

Abstract

BackgroundChemoradiotherapy (CRT) and bio-radiotherapy (BRT) are recognized as standard therapies for head and neck cancer (HNC). Aspiration pneumonia after CRT or BRT is a common late adverse event. Our aim in this study was to evaluate the cause-specific incidence of aspiration pneumonia after CRT or BRT and to identify its clinical risk factors.MethodsWe performed a retrospective analysis of 305 patients with locally advanced HNC treated by CRT or BRT between August 2006 and April 2015.ResultsOf these 305 patients, 65 (21.3%) developed aspiration pneumonia after treatment. The median onset was 161 days after treatment. The two-year cause-specific cumulative incidence by CRT or BRT was 21.0%. Multivariate analysis revealed five independent risk factors for aspiration pneumonia, namely, habitual alcoholic consumption, use of sleeping pills at the end of treatment, poor oral hygiene, hypoalbuminemia before treatment, and the coexistence of other malignancies. A predictive model using these risk factors and treatment efficacy was constructed, dividing patients into low- (0–2 predictive factors), moderate- (3–4 factors), and high-risk groups (5–6 factors), the two-year cumulative incidences of aspiration pneumonia of which were 3.0, 41.6, and 77.3%, respectively. Aspiration pneumonia tended to be associated with increased risk of death, although this was not statistically significant (multivariate-adjusted hazard ratio 1.39, P = 0.18).ConclusionThe cause-specific incidence and clinical risk factors for aspiration pneumonia after definitive CRT or BRT were investigated in patients with locally advanced HNC. Our predictive model may be useful for identifying patients at high risk for aspiration pneumonia.

Highlights

Chemoradiotherapy (CRT) and bio-radiotherapy (BRT) are recognized as standard therapies for head and neck cancer (HNC)
Szczesniak et al [6]. reported that approximately 52% of patients who received RT and 69% who received CRT suffered from dysphasia after treatment, and aspiration pneumonia accounted for 19% of non-cancer-related deaths
Background covariate candidates for factors predictive of aspiration pneumonia included the following: tumor site, age, gender, Eastern Cooperative Oncology SCC Squamous cell carcinoma (Group) (ECOG) performance status, body mass index, TNM staging according to the AJCC/UICC TNM classification, tumor histology, smoking status, habitual alcoholic consumption, distance between the patients’ home and the hospital, family members in the same household, use of proton pump inhibitors (PPIs) or H2 blockers, use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), use of sleeping pills and main feeding at the end of the treatment, presence of gastrostomy during the treatment, oral hygiene, serum albumin (ALB) and hemoglobin (Hb) levels before treatment, coexistence of other malignancies before treatment, and Charlson comorbidity index

Summary

Introduction

Chemoradiotherapy (CRT) and bio-radiotherapy (BRT) are recognized as standard therapies for head and neck cancer (HNC). Chemoradiotherapy (CRT) is a standard treatment for locally advanced head and neck cancer (HNC) [1]. In the previous clinical trial RTOG 91–11 [3], noncancer-related death was more common among patients treated with CRT than with RT alone in a further followup, despite the higher rates of laryngeal preservation [4]. This suggests that patients cured by CRT need appropriate management against late toxicity. Reported that approximately 52% of patients who received RT and 69% who received CRT suffered from dysphasia after treatment, and aspiration pneumonia accounted for 19% of non-cancer-related deaths. < 65 years ≥ 65 years Gender Male Female ECOG performance status 0 1 2 3 Body mass index < 18.5 18.5–25 ≥ 25 Primary site Larynx Nasopharynx Hypopharynx Nasal sinus Oropharynx Oral cavity T-classification 1 2 3 4 N-classification 0 1 2a 2b 2c 3 Tumor histology SCC Others Smoking status Never Past Current Habitual alcoholic consumption Yes No n (%)

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