Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer

• Published in: Radiotherapy and oncology Vol. 151; pp. 266 - 272
• Main Authors: Kanayama, Naoyuki, Otozai, Shinji, Yoshii, Tadashi, Toratani, Masayasu, Ikawa, Toshiki, Wada, Kentaro, Hirata, Takero, Morimoto, Masahiro, Konishi, Koji, Ogawa, Kazuhiko, Fujii, Takashi, Teshima, Teruki
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2020
• Subjects: Aspiration pneumonia; Dysphagia; Esophageal cancer; Head and neck cancer; Head and Neck Neoplasms - radiotherapy; Humans; Hypopharyngeal cancer; Hypopharyngeal Neoplasms; Japan - epidemiology; Pneumonia, Aspiration - etiology; Retrospective Studies; Supraglottic cancer; Japan; Hypopharyngeal cancer; RT; OS; Supraglottic cancer; Aspiration pneumonia; HSC; Head and neck cancer; Dysphagia; HNC; EC; Esophageal cancer
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.08.015

•We assessed risk factors for death unrelated to cancer after definitive RT for HNC.•History of surgery for EC and simultaneous RT for EC are significant risk factors.•Simultaneous RT for HNC and EC should be used with caution. The incidence of hypopharyngeal and supraglottic cancer (HSC) is high in Japan. This study aimed to retrospectively identify risk factors for death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy (RT) for HSC. Overall, 391 patients who began definitive RT for HSC between 2006 and 2014 were identified from the Osaka International Cancer Institute electronic database. Among 391 patients, 33 had a history of surgery for esophageal cancer (EC) and 19 received simultaneous RT for synchronous EC. The cause of death was divided into 3 main categories: “cancer under study,” “other malignancy,” and “unrelated to cancer.” Cox proportional hazard model was used to estimate the hazard ratio (HR). The median follow-up for survivors was 8 (range 3.6–14.1) years. At the last follow-up, 202 patients died. Death from “cancer under study,” “other malignancy,” and “unrelated to cancer” occurred in 92 (45.5%), 55 (27.2%), and 55 (27.2%) patients, respectively. Twelve patients died from aspiration pneumonia. In multivariate analysis for death unrelated to cancer and death from aspiration pneumonia, history of surgery for EC (HR: 3.87, p < 0.001; HR: 6.84, p = 0.007, respectively) and simultaneous RT for synchronous EC (HR: 3.74, p = 0.006; HR: 16.37, p < 0.001, respectively) were significant risk factors. The laryngeal preservation approach by RT for HSC patients with a history of surgery for EC and simultaneous RT for synchronous EC should be used with caution.