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Richard V. Smith, MD; S. Yedida Goldman, MD; Jonathan J. Beitler, MD, MB; Scott S. Wadler, MD

Arch Otolaryngol Head Neck Surg. 2004;130:831-836.

Objective  To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment.

Design  Prospective case series.

Setting  Tertiary care referral center.

Patients  A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy.

Interventions  Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group.

Main Outcome Measures  Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy.

Results  Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/9]) was greater in the 74.4-Gy group (P = .002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P = .002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively.

Conclusion  Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

From the Departments of Otolaryngology (Drs Smith, Goldman, and Beitler) and Radiation Oncology (Dr Beitler), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, and Department of Medical Oncology, Cornell Medical Center, New York, NY (Dr Wadler). The authors have no relevant financial interest in this article.

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