RESUMEN
OBJECTIVES: To determine 1) if timing of esophageal dilation (ED) after radiation therapy (XRT) affects patient's subjective scores of dysphagia, and 2) if specific patient and tumor characteristics affect these scores. DESIGN: Retrospective. METHODS: Electronic medical records of head and neck cancer (HNC) patients who received ED after XRT between 2006-2009 were evaluated for subjective improvement scores of dysphagia. Factors that were evaluated included age (≤ or >50), sex, primary site, T and N-staging, total laryngectomy (TL) +/- cricopharyngeal myotomy (CPM), ± chemotherapy, bougie size (< or ≥ 50), ± TEP at time of dilation, and time from radiation to dilation (<6 months,
Asunto(s)
Cateterismo , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/radioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To determine whether nodal necrosis and node size of 3 cm or larger are risk factors for recurrent neck disease and whether negative computed tomography-positron emission tomography (CT-PET) results 8 weeks or more after therapy indicate complete response in the neck in patients with N2 disease. DESIGN: Retrospective study. SETTING: State university hospital. PATIENTS: Fifty-six patients with head and neck squamous cell cancer and N2 disease treated with chemoradiotherapy were evaluated for persistent or recurrent neck disease. Tumor characteristics analyzed were primary site, T category, nodal size (<3 cm or > or =3 cm), nodal necrosis based on hypodensity of one-third or more of the node, and type of N2 disease (N2a, N2b, or N2c). Forty-eight of the 56 patients underwent CT-PET to determine treatment response after chemoradiotherapy. Clinical examination, imaging, and pathologic specimens were used to confirm disease recurrence. MAIN OUTCOME MEASURES: The number of recurrence events, disease-free interval, and positive posttreatment CT-PET result in the neck. RESULTS: Most patients had oropharyngeal tumors (n = 37; 66%), T2 tumors (n = 21; 38%), nodes 3 cm or larger (n = 43; 77%), positive necrosis (n = 40; 71%), and N2c disease (n = 28; 50%). Multivariate analysis determined that no factors were significant predictors of recurrence, except for positive posttreatment PET results (P < .001). Comparison of CT-PET with nodal recurrence demonstrated a sensitivity of 82%, a specificity of 97%, a negative predictive value of 95%, and a positive predictive value of 90%. CONCLUSION: Posttreatment neck dissections may not be indicated for patients with N2 disease and a negative CT-PET result, even in patients with nodal necrosis and nodes 3 cm or larger.