Aspiration pneumonia affects 74.8% of head and neck cancer patients after chemoradiotherapy

BACKGROUND: Aspiration pneumonia (AP) is one of the most important toxicities associated with chemoradiotherapy. Despite prior studies in definitive chemoradiotherapy, AP incidence and risk factors in postoperative chemoradiotherapy (POCRT) remain poorly defined. The present study investigated the clinical risk factors for AP after POCRT in patients with resected high-risk head and neck cancer. PATIENTS AND METHODS: Patients enrolled in a randomized phase II/III trial (Japan Clinical Oncology Group 1008) were analyzed to measure the incidence of AP, identify the clinical risk factors for AP post-POCRT, and assess the influence of AP on survival outcomes. AP was defined using the guidelines of the Japanese Respiratory Society. Analyses were performed via a logistic regression model. RESULTS: Of 251 patients who underwent POCRT, 100 patients who underwent laryngectomy were excluded. Among the 151 patients who received POCRT, 93 (61.6%), 85 (56.3%), and 113 (74.8%) developed AP during, after, and for an overall period of POCRT intervention, respectively. Multivariable analyses identified two independent risk factors for AP post-POCRT: dysphagia ≥ grade 3 during chemoradiotherapy (CRT) (Odds Ratio [OR] 4.691, p = 0.0009] and reconstruction surgery (OR 2.859, p = 0.0061). The occurrence of AP was not significantly associated with overall survival, relapse-free survival, or local relapse-free survival. CONCLUSIONS: Dysphagia ≥ grade 3 during POCRT and reconstruction surgery were associated with the onset of AP post-POCRT. Careful attention should be paid to these risk factors for AP in patients undergoing POCRT.