Swallowing function after intensity modulated radiotherapy (IMRT) and chemotherapy for head and neck cancer

Abstract

6046 Background: To evaluate the swallowing function of patients treated with intensity modulated radiation therapy (IMRT) + chemotherapy (CT) for HNSCC. Methods: Patients completing RT between 9/04 and 8/06 at the DFCI/BWH were evaluated with IRB approval. All patients had formal swallowing evaluation following the completion of therapy; patients with swallowing difficulty underwent video swallow and both stricture and aspiration were scored. Variables examined for correlation with swallowing pathology were: age, race, gender, smoking and alcohol history, primary site, LVI, PNI, RT intention (primary, postop) and use of induction CT. All variables were analyzed via two-sided t-test. Results: 96 patients were evaluated. Median follow-up 10 mos. 75% of the pts were given definitive RT and 25% received postop RT. 72% stage IV, 24% stage III. Primary sites: oropharynx-43, hypopharynx/larynx-17, oral cavity-13, nasopharynx-11, maxillary sinus-2 and unknown primary-10 pts. All pts received once daily IMRT. 9 pts received RT alone, 28 pts received sequential induction and concurrent (CT) and 59 pts received concurrent CT. 31 pts (32%) had some aspiration after therapy; 36 pts (37%) had evidence of a stricture following RT. All but 5 patients had percutaneous endoscopic gastrostomy placed prophylactically RT. Smoking history was the only significant factor found on univariate analysis to correlate with stricture (p=0.05) but not aspiration. Induction CT was not a significant factor in causing aspiration or stricture. 22 of the strictures (71%) resolved after dilation. RT doses to swallowing structures are under evaluation and will be presented. Conclusions: Aspiration and stricture are common side effects after radical treatment with IMRT and CT for HNSCC. Smoking has a significant negative impact on functional outcome. No significant financial relationships to disclose.