Risk factors for severe dysphagia after concurrent chemoradiotherapy for head and neck cancers

Abstract

Objective: The aim of this study was to investigate the risk factors for dysphagia induced by chemoradiotherapy for head and neck cancers. Methods: Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy from December 1998 to March 2006 were reviewed retrospectively. Median age was 63 years (range, 16 - 81). The locations of the primary lesion were as follows: larynx in 18 patients, oropharynx in 11, nasopharynx in 7, hypopharynx in 7 and others in 4. Clinical stages were as follows: Stage II in 20 and Stages III-IV in 27. Almost all patients underwent platinum-based concomitant chemoradiotherapy. The median cumulative dose of cisplatin was 100 mg/m2 (range, 80 - 300) and median radiation dose was 70 Gy (range, 50-70). Results: Severe dysphagia (Grade 3-4) was observed in 22 patients (47%) as an acute toxic event. One patient required tube feeding even at 12-month follow-up. In univariate analysis, clinical stage (III - IV) (P = 0.017), primary site (oro-hypopharynx) (P = 0.041) and radiation portal size (>11 cm) (P < 0.001) were found to be associated with severe dysphagia. In multivariate analysis, only radiation portal size was found to have a significant relationship with severe dysphagia (P = 0.048). Conclusions: Larger radiation portal field was associated with severe dysphagia induced by chemoradiotherapy. © The Author (2009). Published by Oxford University Press. All rights reserved.