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Delayed lower cranial neuropathy after oropharyngeal intensity‐modulated radiotherapy: A cohort analysis and literature review
Author(s) -
Hutcheson Katherine A.,
Yuk Maggie,
Hubbard Rachel,
Gunn Gary B.,
Fuller C. David,
Lai Stephen Y.,
Lin Heather,
Garden Adam S.,
Rosenthal David I.,
Hanna Ehab Y.,
Kies Merrill S.,
Lewin Jan S.
Publication year - 2017
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24789
Subject(s) - medicine , swallowing , dysphagia , radiation therapy , incidence (geometry) , head and neck cancer , cumulative incidence , oropharyngeal dysphagia , surgery , cohort study , cohort , physics , optics
Abstract Background The purpose of this study was to examine swallowing‐related lower cranial nerve palsy (LCNP) in oropharyngeal cancer (OPC) survivors after intensity‐modulated radiotherapy (IMRT). Methods Patients treated with definitive IMRT (66‐72 Gy) were pooled from institutional trial databases. Prospective analyses on parent trials included videofluoroscopy, clinical LCNP examination, and questionnaires pre‐IMRT, 6 months post‐IMRT, 12 months post‐IMRT, and 24 months post‐IMRT. Time‐to‐event and incidence of LCNP was estimated with competing risk methods. Literature review (1977‐2015) summarized published LCNP outcomes. Results Three of 59 oropharyngeal cancer survivors with a minimum 2‐year follow‐up developed hypoglossal palsy ipsilateral to the index tumor (median latency 6.7 years; range 4.6‐7.6 years). At a median of 5.7 years, cumulative incidence of LCNP was 5%. LCNP preceded progressive dysphagia in all cases. Published studies found median incidence of radiation‐associated LCNP was 10.5% after NPC, but no OPC cancer‐specific estimate. Conclusion Although uncommon, the potential for late LCNP preceding swallowing deterioration highlights the importance of long‐term functional surveillance in OPC survivorship.