Skip to main content
SpringerLink
Log in

Functional Outcomes after Chemoradiotherapy of Laryngeal and Pharyngeal Cancers

  • Head and Neck Cancers (EY Hanna, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Organ preservation regimens that combine chemotherapy and radiotherapy (chemoradiotherapy) are increasingly used as the primary treatment of laryngeal and pharyngeal cancers. Meta-analytic data show a survival benefit with combined modality therapy, but the functional sequelae can be significant. Dysphagia is recognized as a common and often devastating late effect of chemoradiotherapy. This review examines functional outcomes after chemoradiotherapy for laryngeal and pharyngeal cancers, with a particular emphasis on dysphagia. Topics examined include the burden of dysphagia after chemoradiation, pathophysiology of dysphagia, baseline functioning, recommendations to improve long-term function, and voice outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  2. Chen AY, Schrag N, Hao Y, et al. Changes in treatment of advanced laryngeal cancer 1985–2001. Otolaryngol Head Neck Surg. 2006;135:831–7.

    Article  PubMed  Google Scholar 

  3. Zhen W, Karnell LH, Hoffman HT, et al. The National Cancer Data Base report on squamous cell carcinoma of the base of tongue. Head Neck. 2004;26:660–74.

    Article  PubMed  Google Scholar 

  4. Pignon JP, le Maitre A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92:4–14.

    Article  PubMed  Google Scholar 

  5. Trotti A, Bellm LA, Epstein JB, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiother Oncol. 2003;66:253–62.

    Article  PubMed  Google Scholar 

  6. Tschiesner U. Changing the perspective: current trends in the assessment of functional outcome in patients with head and neck cancer. Curr Oncol Rep. 2011;13:126–31.

    Article  PubMed  Google Scholar 

  7. Tschiesner U, Rogers S, Dietz A, et al. Development of ICF core sets for head and neck cancer. Head Neck. 2010;32:210–20.

    PubMed  Google Scholar 

  8. Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870–6.

    PubMed  CAS  Google Scholar 

  9. Rosenthal DI, Mendoza TR, Chambers MS, et al. Measuring head and neck cancer symptom burden: the development and validation of the M. D. Anderson symptom inventory, head and neck module. Head Neck. 2007;29:923–31.

    Article  PubMed  Google Scholar 

  10. Rogers SN, Gwanne S, Lowe D, et al. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck. 2002;24:521–9.

    Article  PubMed  Google Scholar 

  11. •• Francis DO, Weymuller EA, Jr., Parvathaneni U, et al. Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter? Ann Otol Rhinol Laryngol. 2010;119:391–7. Population-based data show highest rates of dysphagia, stricture, and pneumonia in HNC patients treated with chemoradiotherapy compared with other modalities.

    PubMed  Google Scholar 

  12. Suntharalingam M, Kwok Y, Goloubeva O, et al. Phase II study evaluating the addition of cetuximab to the concurrent delivery of weekly carboplatin, paclitaxel, and daily radiotherapy for patients with locally advanced squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 2011 [Epub ahead of print].

  13. Kies MS, Holsinger FC, Lee JJ, et al. Induction chemotherapy and cetuximab for locally advanced squamous cell carcinoma of the head and neck: results from a phase II prospective trial. J Clin Oncol. 2010;28:8–14.

    Article  PubMed  CAS  Google Scholar 

  14. Lefebvre JL, Rolland F, Tesselaar M, et al. Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy. J Natl Cancer Inst. 2009;101:142–52.

    Article  PubMed  CAS  Google Scholar 

  15. Garden AS, Harris J, Trotti A, et al. Long-term results of concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: a phase II trial of the radiation therapy oncology group (RTOG 99–14). Int J Radiat Oncol Biol Phys. 2008;71:1351–5.

    Article  PubMed  Google Scholar 

  16. Cmelak AJ, Li S, Goldwasser MA, et al. Phase II trial of chemoradiation for organ preservation in resectable stage III or IV squamous cell carcinomas of the larynx or oropharynx: results of Eastern Cooperative Oncology Group Study E2399. J Clin Oncol. 2007;25:3971–7.

    Article  PubMed  CAS  Google Scholar 

  17. Bensadoun RJ, Benezery K, Dassonville O, et al. French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: Results at 2 years (FNCLCC-GORTEC). Int J Radiat Oncol Biol Phys. 2006;64:983–94.

    Article  PubMed  CAS  Google Scholar 

  18. Murphy BA, Smith K, Cmelak, A, et al. Swallowing function for patients treated on E2399: A phase II trial of function preservation with induction paclitaxel/carboplatin followed by radiation plus weekly placlitaxel. J Clin Oncol 2006; 24. (abstr 5524)

  19. Givens DJ, Karnell LH, Gupta AK, et al. Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2009;135:1209–17.

    Article  PubMed  Google Scholar 

  20. Goguen LA, Posner MR, Norris CM, et al. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg. 2006;134:916–22.

    Article  PubMed  Google Scholar 

  21. • Caudell JJ, Schaner PE, Meredith RF, et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;73:410–5. Novel composite metric used to estimate prevalence of dysphagia 1 year or more after radiation-based treatment.

    Article  PubMed  Google Scholar 

  22. Worden FP, Kumar B, Lee JS, et al. Chemoselection as a strategy for organ preservation in advanced oropharynx cancer: response and survival positively associated with HPV16 copy number. J Clin Oncol. 2008;26:3138–46.

    Article  PubMed  CAS  Google Scholar 

  23. Hutcheson KA, Barringer DA, Rosenthal DI, et al. Swallowing outcomes after radiotherapy for laryngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2008;134:178–83.

    Article  PubMed  Google Scholar 

  24. Nguyen NP, Moltz CC, Frank C, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15:383–8.

    Article  PubMed  CAS  Google Scholar 

  25. Agarwal J, Palwe V, Dutta D, et al. Objective assessment of swallowing function after definitive concurrent (chemo)radiotherapy in patients with head and neck cancer. Dysphagia. 2011 [Epub ahead of print].

  26. Eisbruch A, Lyden T, Bradford CR, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53:23–8.

    Article  PubMed  Google Scholar 

  27. Best SR, Ha PK, Blanco RG, et al. Factors associated with pharyngoesophageal stricture in patients treated with concurrent chemotherapy and radiation therapy for oropharyngeal squamous cell carcinoma. Head Neck. 2011 [Epub ahead of print].

  28. Lee WT, Akst LM, Adelstein DJ, et al. Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation. Head Neck. 2006;28:808–12.

    Article  PubMed  Google Scholar 

  29. Caglar HB, Tishler RB, Othus M, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:1110–8.

    Article  PubMed  Google Scholar 

  30. Boscolo-Rizzo P, Gava A, Marchiori C, et al. Functional organ preservation in patients with locoregionally advanced head and neck squamous cell carcinoma treated by platinum-based multidrug induction chemotherapy and concurrent chemoradiotherapy. Ann Oncol. 2011;22:1894–901.

    Article  PubMed  CAS  Google Scholar 

  31. Boscolo-Rizzo P, Muzzi E, Trabalzini F, et al. Functional organ preservation after chemoradiotherapy in elderly patients with loco-regionally advanced head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2011;268:1349–55.

    Article  PubMed  Google Scholar 

  32. •• Ang KK. Larynx preservation clinical trial design: summary of key recommendations of a consensus panel. Oncologist. 2010;15 Suppl 3:25–9. Consensus panel recommended inclusion of functional status in the primary end point of future phase III laryngeal preservation trials.

    Article  PubMed  Google Scholar 

  33. Martin M, Lefaix J, Delanian S. TGF-beta1 and radiation fibrosis: a master switch and a specific therapeutic target? Int J Radiat Oncol Biol Phys. 2000;47:277–90.

    Article  PubMed  CAS  Google Scholar 

  34. • Martin S, Chung B, Bratlund C, et al. Movement tracjectories during percutaneous stimulation at rest of the hyolaryngeal muscles in head and neck cancer patients treated with radiation therapy [abstract]. Dysphagia. 2010;25:358. Electromyography found at least partial denervation of critical hyolaryngeal musculature in a majority of patients on a trial for chronic dysphagia after radiotherapy or chemoradiotherapy for HNC.

    Google Scholar 

  35. Ludlow CL, Krisciunas GP, Holsinger FC, et al. Dysphagia (neuropathy/fibrosis) and radiotherapy/chemoradiotherapy. Presented at the Dysphagia Research Society 19th Annual Meeting Post-Graduate Course. San Antonio, TX 2011.

  36. Staton J, Robbins KT, Newman L, et al. Factors predictive of poor functional outcome after chemoradiation for advanced laryngeal cancer. Otolaryngol Head Neck Surg. 2002;127:43–7.

    Article  PubMed  Google Scholar 

  37. • Solares CA, Wood B, Rodriguez CP, et al. Does vocal cord fixation preclude nonsurgical management of laryngeal cancer? Laryngoscope. 2009;119:1130–4. More than half of patients with baseline laryngeal fixation demonstrated recovery of vocal fold mobility after chemoradiation; persistent post-treatment immobility significantly associated with unfavorable survival and functional outcomes.

    Article  PubMed  Google Scholar 

  38. Herchenhorn D, Dias FL, Ferreira CG, et al. Impact of previous tracheotomy as a prognostic factor in patients with locally advanced squamous cell carcinoma of the larynx submitted to concomitant chemotherapy and radiation. ORL J Otorhinolaryngol Relat Spec. 2008;70:381–8.

    Article  PubMed  CAS  Google Scholar 

  39. Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68:1289–98.

    Article  PubMed  Google Scholar 

  40. Schwartz DL, Hutcheson K, Barringer D, et al. Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78:1356–65.

    Article  PubMed  Google Scholar 

  41. Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24:2636–43.

    Article  PubMed  Google Scholar 

  42. Gillespie MB, Brodsky MB, Day TA, et al. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope. 2004;114:1362–7.

    Article  PubMed  Google Scholar 

  43. Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116:883–6.

    Article  PubMed  Google Scholar 

  44. Carroll WR, Locher JL, Canon CL, et al. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118:39–43.

    Article  PubMed  Google Scholar 

  45. Carnaby-Mann GCM, Amdur R, Schmalfuss I. Preventative exercise for dysphagia following head/neck cancer [abstract]. Dysphagia. 2007;22(4):381.

    Google Scholar 

  46. Bhayani M, Hutcheson KA, Barringer DA, et al. Gastrostomy tube placement in patients with hypopharyngeal cancer treated with chemoradiotherapy: Factors affecting placement and dependence [abstract]. Dysphagia. 2011;26:471.

    Google Scholar 

  47. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999;13:557–69.

    Article  PubMed  CAS  Google Scholar 

  48. Rosen CA, Lee AS, Osborne J, et al. Development and validation of the voice handicap index-10. Laryngoscope. 2004;114:1549–56.

    Article  PubMed  Google Scholar 

  49. Oridate N, Homma A, Suzuki S, et al. Voice-related quality of life after treatment of laryngeal cancer. Arch Otolaryngol Head Neck Surg. 2009;135:363–8.

    Article  PubMed  Google Scholar 

  50. Hirano M. Clinical Examination of the Voice. New York, NY: Springer; 1981.

    Google Scholar 

  51. Rutten H, Pop LA, Janssens GO et al. Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic. Int J Radiat Oncol Biol Phys 2010 [Epub ahead of print].

Download references

Acknowledgment

Dr. Hutcheson acknowledges funding from the UT Health Innovation for Cancer Prevention Research Fellowship, The University of Texas School of Public Health—Cancer Prevention and Research Institute of Texas (CPRIT) grant #RP101503. The authors also acknowledge the invaluable support of Janet Hampton and Asher Lisec-Smith.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the CPRIT.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston, TX, 77030, USA

    Katherine A. Hutcheson & Jan S. Lewin

Authors
  1. Katherine A. Hutcheson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan S. Lewin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine A. Hutcheson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hutcheson, K.A., Lewin, J.S. Functional Outcomes after Chemoradiotherapy of Laryngeal and Pharyngeal Cancers. Curr Oncol Rep 14, 158–165 (2012). https://doi.org/10.1007/s11912-012-0216-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-012-0216-1

Keywords

Search

Navigation