Timing of Esophageal Dilation for Dysphagia in Head and Neck Cancer patients receiving Radiation Therapy

Abstract

To determine 1) if timing of esophageal dilation (ED) after radiation therapy (XRT) affects patient's subjective scores of dysphagia, and 2) if specific patient and tumor characteristics affect these scores. Retrospective. Electronic medical records of head and neck cancer (HNC) patients who received ED after XRT between 2006-2009 were evaluated for subjective improvement scores of dysphagia. Factors that were evaluated included age (≤ or >50), sex, primary site, T and N-staging, total laryngectomy (TL) +/- cricopharyngeal myotomy (CPM), ± chemotherapy, bougie size (< or ≥ 50), ± TEP at time of dilation, and time from radiation to dilation (<6 months, <or ≥ 1 year). Post-operative improvement ratings from 0-10 with 10 being the best were measured at various intervals (1 week and 3, 6,9, and 12 months or greater). 26 patients had ED after therapy. 13 (50.0%) patients had TL, and 9 (69.2%) of these patients had a CPM performed at the time of surgery. Majority of patients had ED >6 months (84.6%) and>12 months (69.2%) from XRT. Univariate and multivariate analysis revealed that ED performed <1 year from XRT, no concurrent chemotherapy, and CPM for TL patients had significantly improved scores at all post-operative time intervals (p<0.01) with ED at < 6 months being significant in univariate analysis as well. Esophageal dilations performed <1 year after XRT have improved subjective scores for dysphagia. Patients who have received chemotherapy or did not have CPM at the time of TL may need more aggressive dilations because of poorer outcomes.