Risk Factors for Severe Dysphagia after Concurrent Chemoradiotherapy for Head and Neck Cancers

Objective The aim of this study was to investigate the risk factors for dysphagia induced by chemoradiotherapy for head and neck cancers. Methods Forty-seven patients with head and neck cancers who underwent definitive chemoradiotherapy from December 1998 to March 2006 were reviewed retrospectively. Median age was 63 years (range, 16–81). The locations of the primary lesion were as follows: larynx in 18 patients, oropharynx in 11, nasopharynx in 7, hypopharynx in 7 and others in 4. Clinical stages were as follows: Stage II in 20 and Stages III–IV in 27. Almost all patients underwent platinum-based concomitant chemoradiotherapy. The median cumulative dose of cisplatin was 100 mg/m2 (range, 80–300) and median radiation dose was 70 Gy (range, 50–70). Results Severe dysphagia (Grade 3–4) was observed in 22 patients (47%) as an acute toxic event. One patient required tube feeding even at 12-month follow-up. In univariate analysis, clinical stage (III–IV) (P = 0.017), primary site (oro-hypopharynx) (P = 0.041) and radiation portal size (>11 cm) (P < 0.001) were found to be associated with severe dysphagia. In multivariate analysis, only radiation portal size was found to have a significant relationship with severe dysphagia (P = 0.048). Conclusions Larger radiation portal field was associated with severe dysphagia induced by chemoradiotherapy.