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

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.

Figure 1

Duration in weeks of severe mucositis after definitive concurrent chemotherapy and radiation therapy for oropharyngeal squamous cell carcinoma. Individual patients sorted by stricture outcome. Severe mucositis defined as grade ≥2, National Cancer Institute Common Toxicity Criteria. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

Figure 2

Probability of percutaneous gastrostomy (PEG) dependence after definitive concurrent chemotherapy and radiation therapy for oropharyngeal squamous cell carcinoma. Patients sorted by stricture outcome, censored events (patient died with PEG in place) indicated by tick marks.