2017 Section 7 Green Book

M.C. Ward et al. / Oral Oncology 57 (2016) 21–26

Fig. 1. Cumulative incidence of severe late dysphagia and its components.

Table 3 Cause of death.

Cause of death

Current study

RTOG 91-11

H&N cancer

13 (42%) 6 (19%) 5 (16%) 5 (16%)

38 (29%) 23 (17%) 42 (32%) 18 (14%)

Unknown

Co-morbid illness

Other non-H&N cancer

Acute toxicity

2 (7%) 0 (0%)

9 (7%)

Aspiration pneumonia

<2% (Not specified)

Chi-square p = 0.454.

Factors driving the trending decrease in overall survival seen in larynx cancer since the adoption of chemoradiation remain unclear, but in our experience deaths seem not to be clearly related to late toxicity. Other hypotheses including the treatment of patients with T4 disease with significant soft-tissue invasion or poor compliance with post-treatment follow-up protocols seem possible. The possibility of very late severe dysphagia beginning beyond five years is not excluded by this analysis as multiple patients experienced their first severe late dysphagia event beyond five years. Although the risk of severe late dysphagia was highest within the first two years, this risk did remain for years to come. This entity of very late dysphagia has been previously described by Hutcheson et al, who also described a component of dysphagia originating from cranial nerve dysfunction [11] . The current analy- sis may not have captured cranial nerve dysfunction if it did not require feeding tube placement or hospital admission. Regardless,

Fig. 2. Percent of feeding tubes remaining after the end of radiotherapy.

to this population. The results suggest that although the incidence of severe late dysphagia was significant (26.5% at 5 years), no deaths directly related to severe late dysphagia were observed.

68