O'Hare Jolyne, Maclean Julia, Szczesniak Michal, Gupta Rashmi, Wu Peter, Quon Harry, Cook Ian, Graham Peter
Department of Radiation Oncology, St George Hospital, Sydney, NSW, Australia.
Speech Pathology Department, St George Hospital, Sydney, NSW, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
Oral Oncol. 2017 Jan;64:9-14. doi: 10.1016/j.oraloncology.2016.11.010. Epub 2016 Nov 29.
Aspiration pneumonia is an under-reported treatment sequelae following radiotherapy for head and neck cancer (HNC) patients. This study aims to investigate its incidence and risk factors in this population.
A retrospective review of all HNC patients that had received radiotherapy or chemo radiotherapy with radical intent at a single institution was undertaken (n=206). Dose delivered to the pharyngeal constrictors, base of tongue and cricopharyngeus was calculated and compared between those patients who had died from aspiration pneumonia and those who are alive or had died from other causes.
In a cohort of 206 patients, the median time of follow up was 3.5years (IQR 1.8-4.9years). The cause of death was known in 80 and one of the leading causes of non-cancer related mortality was aspiration pneumonia (n=12) equating to an annual incidence of 0.016. Patients with a tumour located in the larynx had a higher risk of death compared to other sites (p=0.005). The mean cricopharyngeal dose was significantly higher in those patients who died of aspiration pneumonia (p=0.023) compared to those who were still alive or had died from other causes. In a multivariate regression analysis, maximum cricopharyngeal dose is a significant predictor of death from aspiration pneumonia.
Dose to the cricopharyngeus and tumours located within the larynx is associated with an increased mortality due to aspiration pneumonia. Clinical awareness of high risk groups and more studies into causative nature are needed.
吸入性肺炎是头颈部癌（HNC）患者放疗后报告不足的治疗后遗症。本研究旨在调查该人群中其发病率及危险因素。
对在单一机构接受根治性放疗或放化疗的所有HNC患者进行回顾性研究（n = 206）。计算咽缩肌、舌根和环咽肌的受照剂量，并在死于吸入性肺炎的患者与存活或死于其他原因的患者之间进行比较。
在206例患者队列中，中位随访时间为3.5年（四分位间距1.8 - 4.9年）。80例患者的死亡原因已知，非癌症相关死亡的主要原因之一是吸入性肺炎（n = 12），年发病率为0.016。与其他部位相比，肿瘤位于喉部的患者死亡风险更高（p = 0.005）。与存活或死于其他原因的患者相比，死于吸入性肺炎的患者环咽肌平均受照剂量显著更高（p = 0.023）。在多因素回归分析中，环咽肌最大受照剂量是吸入性肺炎死亡的显著预测因素。
环咽肌和喉部肿瘤的受照剂量与吸入性肺炎导致的死亡率增加有关。需要提高对高危人群的临床认识，并对病因进行更多研究。
