Risk factors for aspiration pneumonia during concurrent chemoradiotherapy or bio-radiotherapy for head and neck cancer

Abstract

Background: Aspiration pneumonia (AP) is one of the most important side effects in chemoradiotherapy (CRT) and bio-radiotherapy (BRT) for patients (pts) with head and neck cancer (HNC). AP is involved in on-cancer related mortality in HNC pts. However, the relation between AP during CRT or BRT and treatment outcomes in HNC pts has not been identified. The aims of this study were to assess the influence of AP on treatment outcomes, and to identify clinical risk factors for AP during definitive CRT or BRT for HNC pts. Methods: We retrospectively assessed the data of pts with locally advanced HNC who received definitive CRT or BRT at Shizuoka Cancer Center (August 2006 to December 2016). AP was defined as a clinical condition that met all the following criteria: (i) pts with both subjective and objective symptoms of pneumonia; (ii) the presence of aspiration was suspected clinically (choking or delayed swallowing) or by endoscopy or video-fluorography exams; (iii) no evidence of micro-organisms that cause atypical pneumonia. Results: Of 374 HNC pts who received CRT or BRT, 95 (25.4%) developed AP during treatment. The study cohort of 374 pts had the following features: median age 65 years (range: 19-83); male/female, 322/52; performance status 0/1/2/3, 196/109/14/3; number of metastatic sites 1/2/3/4, 98/60/27/4; primary site larynx/nasopharynx/nasalsinus/ oropharynx/oral-cavity/ear-canal, 57/48/132/21/101/14/1; T-classification 1/2/3/ 4a/4b, 32/136/86/92/28; N-classification (UICC 7th) 0/1/2a/2b/2c/3, 76/54/19/134/75/ 16; induction chemotherapy -/+, 273/101; chemotherapy regimen cisplatin/carboplatin/ cetuximab, 278/64/32. AP was significantly associated with treatment response of CRT or BRT (multivariate-adjusted odds ratio for complete response 0.55, p<0.029). Multivariate analyses identified four independent factors for AP, including poor oral hygiene, high N-classification, hypoalbuminemia before treatment, and inpatient treatment. Conclusions: AP during CRT or BRT has a detrimental effect on treatment response in HNC pts. Careful attention should be paid to AP in HNC pts with these risk factors receiving CRT or BRT.