Success of endoscopic pharyngoesophageal dilation after head and neck cancer treatment

Authors


  • Presented as an oral presentation at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 24–26, 2013.

  • Institution where work was done: Dana-Farber Cancer Institute.

  • Salary for Anna Snavely, PhD, was supported by NIH grant (2 T32 CA 9337-31). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To assess clinical success and safety of endoscopic pharyngoesophageal dilation after chemoradiation or radiation for head and neck cancer and to identify variables associated with dilation failure.

Study Design

Case series with chart review.

Methods

Between 2000 and 2008, a total of 111 patients treated with chemoradiation or radiation for head and neck cancer with subsequent pharyngoesophageal stenosis requiring endoscopic dilation were identified. Patients were evaluated for endoscopic dilation technique, severity of stenosis, technical and clinical success, and intra- and postoperative complications. The Diet/GT score (range, 1–5) was utilized to measure swallow success. Variables associated with dilation failure were analyzed by univariate and multivariate logistic regression.

Results

There were 271 dilations analyzed, with 42 combined antegrade retrograde dilations, 208 dilations over a guidewire, and 21 dilations without guidewire. Intraoperative patency and successful dilation of the stenotic segment was achieved in 95% of patients. A Diet/GT score of 5 (gastrostomy tube removed and soft/regular diet) was attained in 84 of 111 (76%) patients. Safety analysis showed complications occurred in 9% of all dilations. Perforations were noted in 4% of all procedures, with only two esophageal perforations requiring significant intervention. Multiple dilations were associated with an increased risk for perforations. Further logistic regression analyses revealed that the number of dilations was indicating a poor outcome and low Diet/GT score.

Conclusions

Pharyngoesophageal stenosis, occurring after chemoradiation and radiation treatment, can be successfully and safely treated with endoscopic dilation techniques. Patients with restenosis, requiring multiple dilations, have a higher risk of persistent dysphagia.

Level of Evidence

4 Laryngoscope, 123:3066–3073, 2013

Ancillary