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Clinical Trial
. 2014 Apr;36(4):474-80.
doi: 10.1002/hed.23330. Epub 2013 Jun 18.

Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck

Katherine A Hutcheson  1 , Jan S Lewin, F Christopher Holsinger, Ganene Steinhaus, Asher Lisec, Denise A Barringer, Heather Y Lin, Sandra Villalobos, Adam S Garden, Vali Papadimitrakopoulou, Merrill S Kies
Affiliations
Clinical Trial

Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck

Katherine A Hutcheson et al. Head Neck. 2014 Apr.

Abstract

Background: The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN).

Methods: Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years.

Results: Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42).

Conclusion: Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors.

Keywords: functional outcomes; induction chemotherapy; locally advanced squamous carcinoma; sequential chemoradiotherapy; swallowing.

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Figures

Figure 1
Figure 1. CONSORT diagram
Abbreviations: AUC, area under the curve; chemoRT, chemoradiotherapy
Figure 2
Figure 2
Overall survival (OS)
Figure 3
Figure 3. Results of prospective 24-months swallowing measures
*Significantly lower OPSE scores on paste bolus during MBS (p=0.035) and on physical subscale per MDADI questionnaire (p=0.001) at 2 years relative to baseline. Abbreviations: OPSE, Oropharyngeal Swallowing Efficiency; MBS, modified barium swallow study; MDADI, MD Anderson Dysphagia Inventory
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References

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