Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors

作者：Hunter Klaudia U; Lee Oliver E; Lyden Teresa H; Haxer Marc J; Feng Felix Y; Schipper Mathew; Worden Francis; Prince Mark E; McLean Scott A; Wolf Gregory T; Bradford Carol R; Chepeha Douglas B; Ei**ruch Avraham^*

来源：Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 2014, 36(1): 120-125.

DOI：10.1002/hed.23275

• oropharyngeal cancer
• head and neck cancer
• IMRT
• aspiration pneumonia
• dysphagia

BackgroundThe purpose of this study was to assess aspiration pneumonia (AsPn) rates and predictors after chemo-irradiation for head and neck cancer.
MethodsThe was a prospective study of 72 patients with stage III to IV oropharyngeal cancer treated definitively with intensity-modulated radiotherapy (IMRT) concurrent with weekly carboplatin and paclitaxel. AsPn was recorded prospectively and dysphagia was evaluated longitudinally through 2 years posttherapy by observer-rated (Common Toxicity Criteria version [CTCAE]) scores, patient-reported scores, and videofluoroscopy.
ResultsSixteen patients (20%) developed AsPn. Predictive factors included T classification (p = .01), aspiration detected on videofluoroscopy (videofluoroscopy-asp; p = .0007), and patient-reported dysphagia (p = .02-.0003), but not observer-rated dysphagia (p = .4). Combining T classification, patient reported dysphagia, and videofluoroscopy-asp, provided the best predictive model.
ConclusionAsPn continues to be an under-reported consequence of chemo-irradiation for head and neck cancer. These data support using patient-reported dysphagia to identify high-risk patients requiring videofluoroscopy evaluation for preventive measures. Reducing videofluoroscopy-asp rates, by reducing swallowing structures radiation doses and by trials reducing treatment intensity in patients predicted to do well, are likely to reduce AsPn rates.

• 出版日期2014-1