Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma

Richard V. Smith, S. Yedida Goldman, Jonathan J. Beitler, Scott S. Wadler

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. Design: Prospective case series. Setting: Tertiary care referral center. Patients: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. Interventions: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. Main Outcome Measures: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. Results: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/91) was greater in the 74.4-Gy group (P=.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P=.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. Conclusion: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

Original languageEnglish (US)
Pages (from-to)831-836
Number of pages6
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume130
Issue number7
DOIs
StatePublished - Jul 2004

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Deglutition
Radiotherapy
Carcinoma
Gastrostomy
Tertiary Care Centers
Organ Sparing Treatments
Hypopharyngeal Neoplasms
Oropharyngeal Neoplasms
Radiation Dosage
Hydroxyurea
Demography
Outcome Assessment (Health Care)
Radiation
Incidence
Therapeutics
Neoplasms

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma. / Smith, Richard V.; Goldman, S. Yedida; Beitler, Jonathan J.; Wadler, Scott S.

In: Archives of Otolaryngology - Head and Neck Surgery, Vol. 130, No. 7, 07.2004, p. 831-836.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. Design: Prospective case series. Setting: Tertiary care referral center. Patients: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. Interventions: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. Main Outcome Measures: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. Results: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89{\%} [16/18] vs 30{\%} [3/10]) and at 12 months (64{\%} [7/11] vs 11{\%} [1/91) was greater in the 74.4-Gy group (P=.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81{\%} (13/16) vs 11{\%} (1/9) at 4 months and 60{\%} (6/10) vs 11{\%} (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78{\%} (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18{\%} (2/11) in the 60.0-Gy group (P=.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. Conclusion: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.",
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