88 / 220
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.
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. 1.
Cumulative incidence of severe late dysphagia and its components.
Fig. 2.
Percent of feeding tubes remaining after the end of radiotherapy.
Table 3
Cause of death.
Cause of death
Current study
RTOG 91-11
H&N cancer
13 (42%)
38 (29%)
Unknown
6 (19%)
23 (17%)
Co-morbid illness
5 (16%)
42 (32%)
Other non-H&N cancer
5 (16%)
18 (14%)
Acute toxicity
2 (7%)
9 (7%)
Aspiration pneumonia
0 (0%)
<2% (Not specified)
Chi-square
p
= 0.454.
M.C. Ward et al. / Oral Oncology 57 (2016) 21–26
68