Characterization of very late dysphagia after chemoradiation for oropharyngeal squamous cell carcinoma.
Oral Oncol
; 111: 104853, 2020 12.
Article
em En
| MEDLINE
| ID: mdl-32805634
ABSTRACT
OBJECTIVES:
Improved prognosis for p16+ oropharyngeal squamous cell carcinoma (OPSCC) has led to efforts to mitigate long-term complications of treatment, which remains poorly defined in late survivors. Here we characterize very late dysphagia in OPSCC. MATERIALS ANDMETHODS:
Long-term review of 93 p16+ OPSCC patients treated with chemoradiation was performed. We scored videofluoroscopic swallow studies (VFSS) according to the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. Very late dysphagia was defined >2.5â¯years from end of treatment. Fine-Gray regression models were used to assess dysphagia with competing risk of death.RESULTS:
Median follow up was 10.5â¯years. 402 total VFSS were assessed (median 4 per patient, range 0-8). 15.1% of patients had a DIGEST score ≥2 very late after treatment. Very late DIGEST score ≥2 correlated with T-stage (HR 1.7, pâ¯=â¯0.049), second cancer (HR 6.5, pâ¯=â¯0.004), superior pharyngeal constrictor dose (HR 1.11, pâ¯=â¯0.050), total tongue dose (HR 1.07, pâ¯=â¯0.045), but not hypoglossal nerve dose (pâ¯>â¯0.2). Seven patients (7.5%) had late progressive dysphagia, defined as DIGEST score that increased by ≥2 beyond one year after treatment, and this correlated with higher ipsilateral hypoglossal nerve D1cc dose (75 vs 72â¯Gy, pâ¯=â¯0.037).CONCLUSION:
In p16+ OPSCC patients treated with definitive chemoradiation, at least 7.5% developed late progressive dysphagia, and 15.1% experienced moderate dysphagia >2.5â¯years from treatment. Our study suggests that dose to tongue musculature may be associated with very late dysphagia, and hypoglossal nerve dose may be associated with late progressive dysphagia. More intensive long-term dysphagia survivorship monitoring is suggested.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Transtornos de Deglutição
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Neoplasias Orofaríngeas
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Quimiorradioterapia
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Carcinoma de Células Escamosas de Cabeça e Pescoço
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Oral Oncol
Ano de publicação:
2020
Tipo de documento:
Article