Frequency of esophageal stenosis after simultaneous modulated accelerated radiation therapy and chemotherapy for head and neck cancer

Percutaneous feeding tubes in patients with head and neck cancer: rethinking prophylactic placement for patients undergoing chemoradiation

OBJECTIVES

Although intensified therapy has contributed to improved outcomes for patients with head and neck cancer, acute toxicity has increased as well. To lessen the severity of nutritional compromise in these patients, our institutional protocol has been to routinely place feeding tubes before the initiation of therapy. This investigation details the toxicities associated with feeding tube placement and predictors for duration of tube dependence.

MATERIALS AND METHODS

The records of the Radiation Oncology Department at Emory Clinic were reviewed for patients receiving definitive radiotherapy between 6/1/2003 and 6/1/2006. The records of the subset of patients with feeding tube placement before the initiation of therapy were then reviewed for toxicities as well as length of time of tube dependence.

RESULTS

There were 102 eligible patients. Radiotherapy was delivered with concomitant chemotherapy in all. Median time with feeding tube in place for all patients was 4.4 months (range, 0.2-28.9 months). For 82 patients with eventual tube removal, the median time of tube dependence was 3.8 months (range, 1.4-28.9 months). Risk factors for prolonged tube dependence are analyzed; on multivariate analysis, patient age, T stage, and nodal status remained significant. The most common complication was tube replacement, with 11.8% of all tubes requiring replacement. Infection and pain occurred in 8.8% and 5.9% of patients, respectively.

CONCLUSION

Feeding tubes are required for more than 2 months after combined modality treatment of head and neck cancer. They are generally well tolerated, but toxicities are not trivial: more than 10% require replacement and more than 8% of patients develop infection at the insertion site. We are assessing their routine placement in light of these data.

Conservative management of iatrogenic esophageal perforation in head and neck cancer patients with esophageal stricture

Objective: Evaluate the efficacy of conservative management of iatrogenic esophageal perforation following dilatation of a stricture secondary to the treatment of head and neck cancer.

Study Design: Case series with chart review.

Subjects and Methods: Retrospective chart review of 24 patients with esophageal perforation treated at the Detroit Medical Center from 1999 to 2008. Of these, eight head and neck cancer patients had esophageal stricture and underwent dilatation with subsequent esophageal perforation.

Results: Six patients were managed conservatively; two were managed surgically. All eight patients had radiation, six had chemotherapy, and five had surgery as part of their oncologic treatment. Stricture site was at the cricopharyngeus or neopharynx. Perforation size was estimated at 3 to 7 mm in conservative patients and approximately 10 mm in surgical patients. All patients survived to be discharged from the hospital and diet was tube feeds.

Conclusion: In head and neck cancer patients with post-treatment esophageal stricture, iatrogenic cervical esophageal perforations can often be safely managed conservatively. The criteria are: prompt diagnosis within one hour, small perforation (3–7 mm), penetrating type of perforation with circumferential mucosal contact, proximal or cervical esophageal location, and stabilization and improvement of clinical signs and symptoms for 24 hours after initial ICU management.

Late development of esophageal stricture following radiation and chemotherapy for small cell carcinoma of the lung: A case report

Background

The development of esophageal stricture is not an uncommon side effect of radiation and chemotherapy for neck and thoracic malignancies. Depending on the study, it may occur anywhere from 2–3 weeks to 4–8 months after therapy. However, chronic late presentations of post-treatment stricture are highly atypical events.

Case Presentation

The authors describe herein an unusual case of a 65 year old male with esophageal stricture presenting as dysphagia and complicated by multiple episodes of aspiration pneumonia four years after chemoradiation treatment for small cell carcinoma of the lung. The patient's symptoms were ameliorated after esophageal dilation with stenting.

Conclusion

Latent esophageal stricture should be suspected in any patient previously treated with radiation and chemotherapy regardless of how long ago the therapy was initiated.