Incidence and Outcome of Non-Malignant Pharyngeal Ulceration Following Definitive (Chemo)Radiation in Oropharyngeal Squamous Cell Carcinoma (SCC)

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; pp. e800 - e801
• Main Authors: Woody, N.M., Dennert, K., Reddy, C.A., Davis, R.W., Prendes, B., Campbell, S.R., Miller, J.A., Koyfman, S.A., Duggal, R., Fan, C.A., Silver, N., Ku, J., Scharpf, J., Bottalico, D., Geiger, J.L., Sussman, T., Yilmaz, E., Lamarre, E.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.1759

Chemoradiation and radiation alone are a standard of care for a significant proportion of oropharyngeal squamous cell carcinoma (SCC). Pharyngeal ulceration is a complication which may occur following treatment even when not associated with recurrence. We evaluate the incidence and factors associated with non-malignant pharyngeal ulceration (nm-ulcer) and its treatment and resolution. From an IRB approved registry of head and neck cancer patients treated at a tertiary care center we identified non metastatic oropharyngeal squamous cell carcinoma patients undergoing definitive treatment with radiation or chemoradiation between 2010 and 2020. Patient postoperative physical examination, laryngoscope and PET and CT scans were reviewed to identify patients with a pharyngeal ulceration after completion of treatment. Treatment and outcomes of ulcers not associated with recurrence were reviewed. Cumulative incidence of development of nm-ulcer was analyzed as a competing risk against the risk of local recurrence. Predictors of development of these ulcers were analyzed on univariate and multivariable models. A cohort of 719 definitive oropharyngeal SCC were identified with a median age of 60 years and a median follow up of 40.4 months. Forty patients (5.6%) developed nm-ulcer and 40 developed local recurrence. The 12- and 36-month rates of nm-ulcer was 5.6% at both timepoints and the rate of local recurrence was 4.1% and 5.0% at the two timepoints respectively. No significant differences in use of chemotherapy, radiation dose or use of adaptive replanning were noted between nm-ulcer patients and other patients. Among NM ulcer patients, three had associated bone exposure, none had a prior debridement or biopsy and only a single patient was also found to be hypothyroid. Treatment of ulcers included oral antibiotics in 23 (57.5%), narcotics in 29 (72.5%), long-acting narcotics in 28 (70%), feeding tube for pharyngeal rest 7 (17.5%), and surgery 4 (10%). Nm-ulcer was ultimately successfully resolved in 33 (82.5%) at a median time of 3.7 months. On univariate analysis, T3-4 tumor (HR 3.1, 95% CI = 1.6-5.8 p = 0.0005) and smoking (HR 2.2 95%, CI = 1.05-4.5 p = 0.037) were associated with an increased risk of nm-ulcer. On multivariable analysis only T3-4 tumor remained statistically significant (HR 2.95 95%, CI = 1.57-5.54 p = 0.0008) In a modern series of oropharyngeal SCC patients treated with radiation/chemoradiation the rates of non-malignant pharyngeal ulceration following treatment are low but similar to the incidence of local recurrence. Such ulcers commonly require a protracted period of narcotics and may require feeding tube for pharyngeal rest and rarely surgical correction. Larger tumor and current smoking may increase risk.