Factors associated with pharyngoesophageal stricture in patients treated with concurrent chemotherapy and radiation therapy for oropharyngeal squamous cell carcinoma

Authors

  • Simon R. Best MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
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  • Patrick K. Ha MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
    2. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Ray G. Blanco MD,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • John R. Saunders Jr. MD,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Eva S. Zinreich MD,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
    2. Department of Radiation Oncology, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Marshall A. Levine MD,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
    2. Department of Medical Oncology, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Sara I. Pai MD, PhD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
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  • Melissa Walker MS, CCC-SLP,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Jaclyn Trachta MS, SLP,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Karen Ulmer BSN, RN, CORLN,

    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Peter Murakami ScM,

    1. Johns Hopkins University, Biostatistics Consulting Center, Baltimore, Maryland
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  • Richard Thompson PhD,

    1. Johns Hopkins University, Biostatistics Consulting Center, Baltimore, Maryland
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  • Joseph A. Califano MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland
    2. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • Barbara P. Messing MA, CCC-SLP, BRS-S

    Corresponding author
    1. Milton J. Dance, Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
    • Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
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  • This work was presented at the Poster Session of the Combined Otolaryngology Spring Meeting (COSM), April 28–29, 2010, Las Vegas, Nevada.

Abstract

Background

The purpose of this study was to elucidate factors associated with pharyngoesophageal strictures after treatment for head and neck squamous cell carcinoma (SCC).

Methods

We conducted a retrospective review of patients receiving cisplatin and 5-fluorouracil chemotherapy combined with concurrent hyperfractionated radiation therapy for oropharyngeal squamous cell carcinoma.

Results

Strictures developed in 13 of 67 patients (19%). Strictures were associated with tumor location (tonsil vs base of tongue; p = .03), neck dissection after completion of therapy (p = .03), and the duration of treatment-induced mucositis (weeks with mucositis grade ≥2; National Cancer Institute (NCI) Common Toxicity Criteria; p < .001). Age, sex, race, tumor stage, nodal stage, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, smoking, radiation dose, maximum severity of mucositis, amifostine use, and pretreatment swallow dysfunction were not significantly associated with stricture. In multivariate analysis, only duration of mucositis, after controlling for age, sex, and tumor location, remained highly significant (p < .01).

Conclusion

The duration of treatment-related mucositis is an independent risk factor for stricture formation in patients with oropharyngeal SCC treated with concurrent chemotherapy and radiation therapy. © 2011 Wiley Periodicals, Inc. Head Neck, 2011

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