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 separable mucosal adhesions rather than obliteration by a mature fibrous stricture. METHODS: Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001. The diagnosis was confirmed by barium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jesberg esophagoscope under general anesthesia, followed by serial 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 recovered sufficiently to have their gastrostomy tube removed permanently. 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 reconstruction. The postulated pathophysiology has implications for prevention as well as treatment.
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 separable mucosal adhesions rather than obliteration by a mature fibrous stricture. METHODS: Seven patients were referred to the senior author with a diagnosis of complete hypopharyngeal obstruction between 1992 and 2001. The diagnosis was confirmed by barium swallow imaging and/or endoscopy before referral in all patients. Patients underwent recanalization by passing a Jesberg esophagoscope under general anesthesia, followed by serial 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 recovered sufficiently to have their gastrostomy tube removed permanently. 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 reconstruction. The postulated pathophysiology has implications for prevention as well as treatment.
Authors: David Elashoff; Hui Zhou; Jean Reiss; Jianghua Wang; Hua Xiao; Bradley Henson; Shen Hu; Martha Arellano; Uttam Sinha; Anh Le; Diana Messadi; Marilene Wang; Vishad Nabili; Mark Lingen; Darly Morris; Timothy Randolph; Ziding Feng; David Akin; Dragana A Kastratovic; David Chia; Elliot Abemayor; David T W Wong Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-02-01 Impact factor: 4.254
Authors: Hendrik Andreas Wolff; Jan Bosch; Klaus Jung; Tobias Overbeck; Steffen Hennies; Christoph Matthias; Clemens F Hess; Ralph M Roedel; Hans Christiansen Journal: Strahlenther Onkol Date: 2010-04-26 Impact factor: 3.621
Authors: Hendrik A Wolff; Lena-Christin Conradi; Markus Schirmer; Tim Beissbarth; Thilo Sprenger; Margret Rave-Fränk; Steffen Hennies; Clemens F Hess; Heinz Becker; Hans Christiansen; Torsten Liersch Journal: Oncologist Date: 2011-05-09
Authors: Lisette van der Molen; Maya A van Rossum; Lori M Burkhead; Ludi E Smeele; Frans J M Hilgers Journal: Eur Arch Otorhinolaryngol Date: 2008-09-30 Impact factor: 2.503