Evaluating predictive factors for chemoradiotherapy related dysphagia in patients with head and neck cancer.

The treatment of head and neck cancers has progressed over the years which yields a better chance of long-term survival. Nevertheless, treatment intensification also increases rates of treatment related toxicities. Dysphagia is an underestimated, yet challenging, complain of head and neck cancer patients undergoing chemoradiotherapy. This retrospective study aims to determine if there are any variables that can be used as predictive factors for this outcome.

All patients diagnosed with head and neck cancer that underwent treatment with definitive chemoradiotherapy with cisplatin every 3 weeks at our center, between 2018 and 2022, were included. Patients that had dysphagia prior to treatment, who died before the end of treatment and patients that lost follow-up within 6 months after treatment end, were excluded. Considering the latter, we collected a sample of 42 individuals from which we obtained data concerning gender, age (< 65 years old vs. ≥ 65 years old), smoking history, HPV status, cancer type (oropharyngeal vs non-oropharyngeal), treatment radiation dose (< 70Gy vs ≥ 70Gy), number of cisplatin cycles and early and late dysphagia outcomes using the CTCAE scale. To evaluate the association between any of these categorical variables and early/late dysphagia outcomes, we applied Fisher's exact test, given the small counts, using the EasyR® software. 

Most of our sample included male patients (N = 37; 88,1%) and heavy smokers (N = 34; 80% with > 10 units pack year); with a mean age of 62 years at the time of diagnosis. The most frequent type of cancer was oropharyngeal (N = 21; 50%) followed by laryngeal cancer (N = 12; 28,6%). For early dysphagia, HPV status (p = 0,0357) was significantly associated with outcome, whereas in later dysphagia treatment radiation dose (p = 0,0291) was significantly associated with outcome.

As far as we know, the association between HPV and treatment related dysphagia has not been established. Our results indicate that HPV status has an influence in the patient's risk of developing early dysphagia while treatment radiation dose influences the risk of developing late dysphagia.