Abstract
BackgroundAspiration pneumonia is one of the most important side effects of chemoradiotherapy (CRT) and bio-radiotherapy (BRT) in patients with head and neck cancer (HNC). Aspiration pneumonia can lead to cancer-related mortality in HNC patients. However, the relationship between aspiration pneumonia occurring during CRT or BRT for HNC and treatment outcomes in HNC patients is not well characterized. In this study, we assessed the influence of aspiration pneumonia on treatment outcomes and sought to identify the clinical risk factors for aspiration pneumonia during definitive CRT and BRT in HNC patients.MethodsWe retrospectively assessed the data pertaining to patients with locally advanced HNC who received definitive CRT or BRT at the Shizuoka Cancer Center between August 2006 and December 2016.ResultsAmong the 374 HNC patients who received CRT or BRT, 95 (25.4%) developed aspiration pneumonia during treatment. Aspiration pneumonia was significantly associated with therapeutic response to CRT or BRT (multivariate adjusted odds ratio for complete response, 0.52, p = 0.020) and poor overall survival (multivariate adjusted hazard ratio for overall survival, 1.58, p = 0.024). The multivariate analyses identified four independent factors for aspiration pneumonia: poor oral hygiene, high N-classification, hypoalbuminemia before treatment, and inpatient treatment.ConclusionsAspiration pneumonia occurring during CRT or BRT has a detrimental effect on the therapeutic response and survival of HNC patients. Careful attention should be paid to these risk factors for aspiration pneumonia in HNC patients undergoing CRT or BRT.
Highlights
Aspiration pneumonia is one of the most important side effects of chemoradiotherapy (CRT) and bioradiotherapy (BRT) in patients with head and neck cancer (HNC)
We reviewed the following treatment-related variables: the presence or absence of induction chemotherapy, percutaneous endoscopic gastrostomy prior to treatment, inpatient or outpatient treatment, chemotherapy regimen, radiation technique, irradiation field, radiation dose, treatment efficacy evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 [complete response (CR) or non-CR] [16], mucositis during treatment evaluated by the Common Terminology Criteria for Adverse Events version 4.0, and dysphagia score during treatment [17]
We investigated the predictive factors of therapeutic response in HNC patients undergoing CRT or BRT and identified aspiration pneumonia as an independent predictive factor for complete response (CR)
Summary
Aspiration pneumonia is one of the most important side effects of chemoradiotherapy (CRT) and bioradiotherapy (BRT) in patients with head and neck cancer (HNC). We assessed the influence of aspiration pneumonia on treatment outcomes and sought to identify the clinical risk factors for aspiration pneumonia during definitive CRT and BRT in HNC patients. A few studies have investigated aspiration pneumonia during treatment [14], the incidence or risk factors of aspiration pneumonia in patients receiving CRT and BRT are not well characterized. The aim of this study was to assess the effect of aspiration pneumonia during definitive CRT and BRT on treatment outcomes and to identify the clinical risk factors for aspiration pneumonia in HNC patients. < 70 years ≥ 70 years Gender Male Female ECOG performance status 0 1 2 3 Body mass index < 20 ≥ 20 Primary site Larynx Nasopharynx Hypopharynx Nasal sinus Oropharynx Oral cavity Ear canal T-classification 1 2 3 4a 4b N-classification 0 1 2a 2b 2c 3 Tumor histology SCC Others Brinkman index < 500 ≥ 500 Habitual alcoholic consumption Yes No Use of ACEi or ARB Yes n (%) 69 (18)
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