Swallowing function after chemoradiation for advanced stage oropharyngeal cancer

Samuel G. Shiley, Christopher A. Hargunani, Judith M. Skoner, John Holland, Mark Wax

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Advanced-stage oropharyngeal cancer may be treated either surgically or nonsurgically. We reported previously functional outcomes after surgical resection with free-tissue transfer. In the present study, we evaluated swallowing function after combined chemoradiation for oropharyngeal cancer. STUDY DESIGN AND SETTING: Retrospective review of 30 patients treated at a tertiary academic center for Stage III/IV oropharyngeal cancer with sequential or concurrent chemoradiation from 1994 to 2003. RESULTS: Inclusion criteria were met by 27 of 30 (90%) patients. Most patients had base of tongue lesions (67%) and Stage IV disease (93%). Gastrostomy was carried out in 22 (82%) patients either before or during treatment. Three months after chemoradiation, 33% (9/27) were consuming all nutrition orally, 22% (6 of 27) were NPO, and 45% (12 of 27) had some oral intake but still required tube feeds. One year after treatment, 53% (10 of 19) had an exclusively oral diet whereas 47% still required tube feeds including 1 patient (5%) who was NPO. In patients without recurrence and follow-up length >1 year, 69% (9 of 13) were consuming all nutrition orally whereas 31% still required gastrostomy tube (G-tube) support. A higher rate of G-tube dependence was observed in patients treated for base of tongue lesions vs tonsil lesions (67% vs 25%, P = 0.049, χ2 analysis). CONCLUSIONS: At this institution, the short-term (3-4 months) rate of G-tube dependence was similar after surgical and non-surgical treatment of oropharyngeal cancer. One year after chemoradiation, 31% of patients without recurrence still required tube feeds. SIGNIFICANCE: These results suggest that organ-preservation protocols do not reduce the prevalence of chronic dysphagia and G-tube dependence after management of oropharyngeal cancer. EBM rating: C-4

Original languageEnglish (US)
Pages (from-to)455-459
Number of pages5
JournalOtolaryngology - Head and Neck Surgery
Volume134
Issue number3
DOIs
StatePublished - Mar 2006

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Oropharyngeal Neoplasms
Deglutition
Gastrostomy
Tongue
Organ Preservation
Recurrence
Palatine Tonsil
Deglutition Disorders
Therapeutics
Diet

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Swallowing function after chemoradiation for advanced stage oropharyngeal cancer. / Shiley, Samuel G.; Hargunani, Christopher A.; Skoner, Judith M.; Holland, John; Wax, Mark.

In: Otolaryngology - Head and Neck Surgery, Vol. 134, No. 3, 03.2006, p. 455-459.

Research output: Contribution to journalArticle

Shiley, Samuel G. ; Hargunani, Christopher A. ; Skoner, Judith M. ; Holland, John ; Wax, Mark. / Swallowing function after chemoradiation for advanced stage oropharyngeal cancer. In: Otolaryngology - Head and Neck Surgery. 2006 ; Vol. 134, No. 3. pp. 455-459.
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abstract = "OBJECTIVE: Advanced-stage oropharyngeal cancer may be treated either surgically or nonsurgically. We reported previously functional outcomes after surgical resection with free-tissue transfer. In the present study, we evaluated swallowing function after combined chemoradiation for oropharyngeal cancer. STUDY DESIGN AND SETTING: Retrospective review of 30 patients treated at a tertiary academic center for Stage III/IV oropharyngeal cancer with sequential or concurrent chemoradiation from 1994 to 2003. RESULTS: Inclusion criteria were met by 27 of 30 (90{\%}) patients. Most patients had base of tongue lesions (67{\%}) and Stage IV disease (93{\%}). Gastrostomy was carried out in 22 (82{\%}) patients either before or during treatment. Three months after chemoradiation, 33{\%} (9/27) were consuming all nutrition orally, 22{\%} (6 of 27) were NPO, and 45{\%} (12 of 27) had some oral intake but still required tube feeds. One year after treatment, 53{\%} (10 of 19) had an exclusively oral diet whereas 47{\%} still required tube feeds including 1 patient (5{\%}) who was NPO. In patients without recurrence and follow-up length >1 year, 69{\%} (9 of 13) were consuming all nutrition orally whereas 31{\%} still required gastrostomy tube (G-tube) support. A higher rate of G-tube dependence was observed in patients treated for base of tongue lesions vs tonsil lesions (67{\%} vs 25{\%}, P = 0.049, χ2 analysis). CONCLUSIONS: At this institution, the short-term (3-4 months) rate of G-tube dependence was similar after surgical and non-surgical treatment of oropharyngeal cancer. One year after chemoradiation, 31{\%} of patients without recurrence still required tube feeds. SIGNIFICANCE: These results suggest that organ-preservation protocols do not reduce the prevalence of chronic dysphagia and G-tube dependence after management of oropharyngeal cancer. EBM rating: C-4",
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