Timing of esophageal dilation for dysphagia in head and neck cancer patients receiving radiation therapy.

OBJECTIVES: To determine 1) if timing of esophageal dilation (ED) after radiation therapy (XRT) affects patient's subjective scores of dysphagia, and 2) if specific patient and tumor characteristics affect these scores. DESIGN: Retrospective. METHODS: Electronic medical records of head and neck cancer (HNC) patients who received ED after XRT between 2006-2009 were evaluated for subjective improvement scores of dysphagia. Factors that were evaluated included age (≤ or >50), sex, primary site, T and N-staging, total laryngectomy (TL) +/- cricopharyngeal myotomy (CPM), ± chemotherapy, bougie size (< or ≥ 50), ± TEP at time of dilation, and time from radiation to dilation (<6 months, 6 months (84.6%) and>12 months (69.2%) from XRT. Univariate and multivariate analysis revealed that ED performed <1 year from XRT, no concurrent chemotherapy, and CPM for TL patients had significantly improved scores at all post-operative time intervals (p<0.01) with ED at < 6 months being significant in univariate analysis as well. CONCLUSIONS: Esophageal dilations performed <1 year after XRT have improved subjective scores for dysphagia. Patients who have received chemotherapy or did not have CPM at the time of TL may need more aggressive dilations because of poorer outcomes.

N2 disease in patients with head and neck squamous cell cancer treated with chemoradiotherapy: is there a role for posttreatment neck dissection?

OBJECTIVES: To determine whether nodal necrosis and node size of 3 cm or larger are risk factors for recurrent neck disease and whether negative computed tomography-positron emission tomography (CT-PET) results 8 weeks or more after therapy indicate complete response in the neck in patients with N2 disease. DESIGN: Retrospective study. SETTING: State university hospital. PATIENTS: Fifty-six patients with head and neck squamous cell cancer and N2 disease treated with chemoradiotherapy were evaluated for persistent or recurrent neck disease. Tumor characteristics analyzed were primary site, T category, nodal size (<3 cm or > or =3 cm), nodal necrosis based on hypodensity of one-third or more of the node, and type of N2 disease (N2a, N2b, or N2c). Forty-eight of the 56 patients underwent CT-PET to determine treatment response after chemoradiotherapy. Clinical examination, imaging, and pathologic specimens were used to confirm disease recurrence. MAIN OUTCOME MEASURES: The number of recurrence events, disease-free interval, and positive posttreatment CT-PET result in the neck. RESULTS: Most patients had oropharyngeal tumors (n = 37; 66%), T2 tumors (n = 21; 38%), nodes 3 cm or larger (n = 43; 77%), positive necrosis (n = 40; 71%), and N2c disease (n = 28; 50%). Multivariate analysis determined that no factors were significant predictors of recurrence, except for positive posttreatment PET results (P < .001). Comparison of CT-PET with nodal recurrence demonstrated a sensitivity of 82%, a specificity of 97%, a negative predictive value of 95%, and a positive predictive value of 90%. CONCLUSION: Posttreatment neck dissections may not be indicated for patients with N2 disease and a negative CT-PET result, even in patients with nodal necrosis and nodes 3 cm or larger.