Abstract
OBJECTIVE
1) Assess swallowing function following chemoradiotherapy(CRT) and neck dissection(ND) in head and neck cancer(HNC) patients. 2) Determine clinical and treatment factors associated with prolonged gastrostomy tube (GT) dependence.
METHOD
Patients undergoing ND after CRT for advanced HNC between 1998-2008 were reviewed. Weight, diet, GT dependency and video swallow studies were examined. Univariate analysis was used to distinguish factors associated with prolonged GT dependence.
RESULTS
Eighty-eight patients were identified. Neck dissections were performed at median 10 weeks after CRT. The peak weight loss was 16.4% at 6 months after CRT. Weight loss at 24 months was 11.3%. Post-CRT assessments at 6, 12 and 24 months showed a soft or regular diet was taken by 68%, 89%, and 91%. The GT was removed in 47%, 75%, and 90% at 6, 12 and 24 months, respectively. The median time to GT removal post-CRT was 6.95 months. The GT remained in 5 patients(6%) over the follow-up period. Video swallow studies post-ND were available for 56 patients and demonstrated pharyngoesophageal stenosis in 28. Twenty-six underwent dilation that was successful in 93% of patients. Analyses of multiple clinical and treatment factors revealed an increased risk for prolonged GT dependency beyond 12 months for T3-4(44%) compared to T1-2 (16%, p = 0.0126).
CONCLUSION
Despite the addition of ND to CRT, nearly all patients took a soft or regular diet by 12 months and only 6% of patients remained long-term GT-dependent. A higher tumor stage contributes to GT dependency beyond 12 months.