Complete hypopharyngeal obstruction by mucosal adhesions: A complication of intensive chemoradiation for advanced head and neck cancer
| Autor: | Elizabeth J. Franzmann, W. Jarrard Goodwin, Andre A. Abitbol, Donna S. Lundy |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Perforation (oil well) Antineoplastic Agents Tissue Adhesions Swallowing medicine Humans Aged Retrospective Studies Gastrostomy Mucous Membrane Radiotherapy medicine.diagnostic_test business.industry Head and neck cancer Pharyngeal Diseases Middle Aged medicine.disease Combined Modality Therapy Head and neck squamous-cell carcinoma Endoscopy Surgery Laryngectomy Radiation therapy Hypopharynx Treatment Outcome Otorhinolaryngology Head and Neck Neoplasms Carcinoma Squamous Cell Female Deglutition Disorders business Chemoradiotherapy |
| Zdroj: | Head & Neck. 28:663-670 |
| ISSN: | 1097-0347 1043-3074 |
| DOI: | 10.1002/hed.20392 |
| Popis: | Background. Severe swallowing dysfunction is the dominant long-term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separa- ble mucosal adhesions rather than obliteration by a mature fi- brous stricture. Methods. Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction be- tween 1992 and 2001. The diagnosis was confirmed by bar- ium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jes- berg esophagoscope under general anesthesia, followed by se- rial dilations and intensive swallowing therapy. Patient charts were reviewed retrospectively after institutional review board approval. Results. All seven patients were successfully recanalized. No patient had a perforation or other significant complication related to the recanalization procedure or subsequent dilations. Five of the seven patients showed improvement in swallowing at some point after the initial procedure, but just two patients recov- ered sufficiently to have their gastrostomy tube removed perma- nently. Conclusions. We conclude that complete hypopharyngeal obstruction secondary to mucosal adhesions is one cause of gastrostomy tube dependence in patients who have been treated with chemo/XRT for HNSCC. It is a difficult problem to treat, but most patients can recover useful swallowing function without undergoing laryngectomy or major surgical reconstruc- tion. The postulated pathophysiology has implications for pre- vention as well as treatment. V C 2006 Wiley Periodicals, Inc. Head Neck 28: 663-670, 2006 |
| Databáze: | OpenAIRE |
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