SWALLOWING FUNCTION FOLLOWING MULTISPECIALTY ORGAN PRESERVATION TREATMENT OF ADVANCED HEAD AND NECK-CANCER

e17020 Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL. No significant financial relationships to disclose.

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Impact of chemoradiotherapy for locally advanced head and neck cancer on swallowing function

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6054 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6054-6054

Author(s):

E. Burke ◽

L. Goguen ◽

R. Tishler ◽

L. Wirth ◽

M. Posner ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Locally Advanced ◽

Advanced Head ◽

Swallowing Function ◽

Pharyngeal Residue ◽

Feeding Tubes ◽

Post Radiation ◽

The Impact

6054 Background: We examined the impact of chemoradiotherapy (CRT) on swallowing function in a group of patients treated for locally advanced head and neck cancer in an ongoing randomized phase II study with concurrent CRT, with or without Ethyol. Methods: Chemotherapy consisted of weekly carboplatin AUC 1.5 and paclitaxel at 45 /m2 for 4 weeks. Radiation was delivered using a 3 field technique with a concomitant boost schedule to a total dose of 72 Gy. Patients were randomized to receive or not receive daily subcutaneous Ethyol. Patients had video swallow studies at the start of radiation and 8, 12, 24 and 52 weeks post chemoradiotherapy. Dysphagia and weight loss were monitored. Video swallow study reports were collected and the incidence of penetration, aspiration, pharyngeal residue and upper esophageal narrowing analyzed. Results: Baseline data were available for 31 patients out of 43 enrolled. 29% of the patients penetrated, 6.4% aspirated and 29% had pharyngeal residue. Patients on both arms of the study had a steady decline in swallowing function from onset until 24 weeks post radiation. Penetration, aspiration and pharyngeal residue were consistently noted at all time points and improvements in deglutition were seen on the 52-week post radiation video swallow. Forty percent of the patients (17/43) had narrowing in the upper esophagus. On average, a third of the patients examined required dilations. The remaining patients with esophageal narrowing were able to advance their diet and have their feeding tubes removed without dilations. The average time from the end of the treatment to PEG removal was 219 days. Conclusion: Based on the video swallow studies that were conducted, patients had a gradual decline in swallowing function from initiation of CRT until 24 weeks post. Esophageal narrowing was common, often requiring dilation. Given that it takes 7 months on average for the feeding tubes to come out, we recommend that these patients undergo intensive swallowing therapy and continuous long term follow up and assessment at two and possibly three years post CRT. Study is ongoing. No significant financial relationships to disclose.

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Improvement of a Delayed Swallowing Reflex Following Treatment for Advanced Head and Neck Cancer

10.21203/rs.3.rs-16480/v3 ◽

2020 ◽

Author(s):

Akira Ohkoshi ◽

Kengo Kato ◽

Takenori Ogawa ◽

Ayako Nakanome ◽

Ryo Ishii ◽

...

Keyword(s):

Head And Neck Cancer ◽

Retrospective Study ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Advanced Head ◽

Silent Aspiration ◽

Swallowing Function ◽

Before And After ◽

Swallowing Reflex

Abstract Background: The latency of the swallowing reflex is an important factor causing dysphagia in head and neck cancer patients. Although there are many reports comparing voluntary swallowing function before and after treatment, few studies have focused on the latency of the swallowing reflex, which is a risk factor for pneumonia due to silent aspiration. The aim of this retrospective study was to clarify the changes in the latency of the swallowing reflex before and after treatment. Methods: The latency of the swallowing reflex was quantified using the time from the injection of 1 ml of distilled water into the pharynx through a nasal catheter to the onset of swallowing. Results: The latency time of the swallowing reflex was significantly decreased 3 months after treatment compared to before treatment. A significant reduction was also observed in patients with pharyngeal cancer who underwent chemoradiation therapy. Conclusions: This retrospective study showed that a delayed swallowing reflex improved with treatment in advanced head and neck cancer patients.

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Workshop report: Organ preservation strategies in advanced head and neck cancer—Current status and future directions

Head & Neck ◽

10.1002/(sici)1097-0347(199912)21:8<689::aid-hed2>3.0.co;2-0 ◽

1999 ◽

Vol 21 (8) ◽

pp. 689-693 ◽

Cited By ~ 21

Author(s):

Gregory T. Wolf ◽

Arlene Forastiere ◽

Kian Ang ◽

Bruce Brockstein ◽

Barbara Conley ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Organ Preservation ◽

Current Status ◽

Advanced Head ◽

Future Directions ◽

Workshop Report

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Taxane-based chemoirradiation for organ preservation with locally advanced head and neck cancer: Results of a phase II multi-institutional trial

Head & Neck ◽

10.1002/hed.20522 ◽

2007 ◽

Vol 29 (4) ◽

pp. 315-324 ◽

Cited By ~ 19

Author(s):

Anthony J. Cmelak ◽

Barbara A. Murphy ◽

Brian Burkey ◽

Stacy Douglas ◽

Yu Shyr ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Phase Ii ◽

Neck Cancer ◽

Organ Preservation ◽

Locally Advanced ◽

Advanced Head

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Organ Preservation for Advanced Head and Neck Cancer Concomitant Chemoradiation

Head and Neck Cancer - Cancer Treatment and Research ◽

10.1007/0-306-48060-3_9 ◽

2006 ◽

pp. 235-248 ◽

Cited By ~ 3

Author(s):

Bruce Brockstein

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Organ Preservation ◽

Advanced Head ◽

Concomitant Chemoradiation

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Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of A National Survey Among Radiation Oncologists

10.21203/rs.3.rs-70709/v1 ◽

2020 ◽

Author(s):

Tatiana Dragan ◽

Fréderic Duprez ◽

André Van Gossum ◽

Akos Gulyban ◽

Sylvie Beauvois ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Radiation Oncology ◽

Locally Advanced ◽

Oral Feeding ◽

Gastrostomy Tube ◽

Anatomical Site ◽

Advanced Head ◽

Swallowing Function

Abstract Background: Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers.Methods: A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement.Results: All 24 center submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by ‘anatomical site’, ‘patients’ choice’ and ‘postoperative versus definitive’ and ‘local expertise’, with decreasing importance respectively. Disagreement indexes showed moderate variation.Conclusions: The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

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