1. Characteristics and Management of Post Treatment Pharyngeal Ulceration in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Definitive Radiation/Chemoradiation.
- Author
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Woody, N.M., Prendes, B., Dennert, K., Campbell, S.R., Duggal, R., Fan, C.A., Buchberger, D.S., Ku, J., Scharpf, J., Geiger, J.L., Yilmaz, E., Sussman, T., Silver, N., Miller, J., Karasik, N., Davis, R.W., Bottalico, D., Koyfman, S.A., and Lamarre, E.
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SQUAMOUS cell carcinoma , *HEAD & neck cancer , *PRESSURE ulcers , *CHEMORADIOTHERAPY , *OROPHARYNGEAL cancer , *PLASTIC surgery , *FEEDING tubes - Abstract
Treatment of oropharyngeal cancer with definitive radiation/chemoradiation (RT/CRT) is an effective treatment and rapid regression of tumor can occur. Following treatment some patients will develop a pharyngeal ulcer which may or may not be associated with disease persistence. Data for the management of ulcers could improve post radiation care. From an IRB approved database of head and neck cancer cases at a tertiary care center, we reviewed patients with non-metastatic squamous cell carcinoma of the oropharynx treated curatively in non-operative fashion with RT/CRT between 1/1/2011 and 1/1/2022. Patients were reviewed for clinical, radiographic and laryngoscopic evidence of pharyngeal ulcer development following completion of radiation. Pharyngeal ulcer patients were evaluated for management strategy of the ulcer and associated complications and association with recurrence. A total of 45 patients with a pharyngeal ulceration following RT/CRT with a median follow up of 30.8 months were identified. The median age of patients was 60 (range 35-82) years, 80% of patients were caucasian, 82% were male, and 42% of patients were active smokers at the time of RT/CRT. 75% of patients had p16/HPV+ disease with T stages of T1/2, T3 and T4 of 44, 20 and 36% respectively. 93% of patients were treated with concurrent chemotherapy (74% cisplatin) to a median dose of 70 Gy (range 60-74 Gy). The median time to development of ulcer was 3.1 months (range 0.2-31.4 months). 19 patients (42%) underwent biopsy of their ulcer of whom 9 (47%) where found to have disease persistence. Ultimately thirteen patients (29%) had associated tumor persistence. Among the 32 patients with ulcer not associated with recurrence, 28 (87.5%) were p16/HPV+ and 90.6% has received chemotherapy. 3 ulcers (9.4%) were associated with exposed bone. Treatment of ulcers revealed 15 (46%) received antibiotics, 23 (72%) needed narcotics and 5 (16%) required feeding tube placement for pharyngeal rest. Three patients (9.4%) required surgical reconstruction to facilitate resolution. Overall, at time of last follow up 28 (88%) of ulcers not associated cancer had resolved with a median time to resolution of 3.6 months (range 1.3-75.2) months. The overall survival of the non-malignant ulcer group was 83% at 3 years compared to 28% in the patients with ulcers associated with persistent cancer. Pharyngeal ulceration is a significant potential complication of RT/CRT in oropharyngeal cancer. Ulceration is frequently identified around 3 months post treatment and when not associated with disease persistence has a high rate of resolution with conservative measures including antibiotics and pain control. Severe case may necessitate feeding tube and rarely surgical reconstruction. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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