Hutcheson Katherine A, Abualsamh Amal R, Sosa Alejandro, Weber Randal S, Beadle Beth M, Sturgis Erich M, Lewin Jan S
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Head Neck. 2016 Jun;38(6):886-93. doi: 10.1002/hed.24195. Epub 2015 Sep 4.
Conflicting results are reported regarding the impact of neck dissection on radiation-associated dysphagia. The purpose of this study was to reexamine this question specific to oropharyngeal intensity-modulated radiotherapy (IMRT).
Three hundred forty-nine patients with oropharyngeal cancer treated with bilateral IMRT with systemic therapy (induction and/or concurrent) were reviewed. Chronic dysphagia was defined by aspiration, stricture, pneumonia, and/or gastrostomy dependence ≥12 months post-IMRT.
Selective neck dissection was performed after IMRT in 75 patients (21%). Overall, 41 patients (12%) developed chronic dysphagia. Neck dissection did not increase the rate of chronic dysphagia (9% neck dissection; 12% no neck dissection; p = .464) or gastrostomy duration (p = .482). On multivariate analysis, age (odds ratio [OR] per 5-year = 1.25; 95% confidence interval [CI] = 1.04-1.51), baseline abnormal diet (OR = 2.78; 95% CI = 1.31-5.88), and IMRT dose (OR per 5-Gy = 5.11; 95% CI = 1.77-14.81) significantly predicted dysphagia.
In the setting of selective neck dissection for residual adenopathy after IMRT, neck dissection did not impact dysphagia. © 2015 Wiley Periodicals, Inc. Head Neck 38: 886-893, 2016.
关于颈部清扫术对放射性吞咽困难的影响，报道结果相互矛盾。本研究的目的是针对口咽癌调强放疗（IMRT）重新审视这一问题。
回顾了349例接受双侧IMRT联合全身治疗（诱导和/或同步）的口咽癌患者。慢性吞咽困难定义为IMRT后≥12个月出现误吸、狭窄、肺炎和/或胃造口依赖。
75例患者（21%）在IMRT后进行了选择性颈部清扫术。总体而言，41例患者（12%）出现慢性吞咽困难。颈部清扫术并未增加慢性吞咽困难的发生率（颈部清扫术组为9%；未行颈部清扫术组为12%；p = 0.464）或胃造口持续时间（p = 0.482）。多因素分析显示，年龄（每5岁的比值比[OR]=1.25；95%置信区间[CI]=1.04 - 1.51）、基线饮食异常（OR = 2.78；95% CI = 1.31 - 5.88）和IMRT剂量（每5 Gy的OR = 5.11；95% CI = 1.77 - 14.81）显著预测吞咽困难。
在IMRT后对残留淋巴结病进行选择性颈部清扫术的情况下，颈部清扫术不影响吞咽困难。©2015威利期刊公司。《头颈》38: 886 - 893, 2016年。
