Swallowing disorders may warrant routine esophagoscopy examination in patients with HNSCC
No definite index of symptoms and signs indicated local recurrence or second primary malignancy in patients treated for head and neck squamous cell carcinoma, according to study results.
However, the researchers strongly recommended routine transnasal esophagoscopy examination for these patients who experience swallowing disorders.
“In patients treated for head and neck squamous cell carcinoma (HNSCC), the incidences of local recurrence and secondary primary malignancy are relatively high,” Tseng-Cheng Chen, MD, of the department of otolaryngology at National Taiwan University Hospital and National Taiwan University College of Medicine in Taipei, and colleagues wrote. “In routine practice, a clinician inspects the development of local recurrence or secondary primary malignancy in patients treated for HNSCC by observing any symptoms and signs of swallowing disorders. However, the associated morbidities from previous treatment also can result in swallowing disorders. Therefore, swallowing disorders in patients treated for HNSCC are easily and frequently ignored in routine practice.”
Chen and colleagues sought to develop an index of signs and symptoms of swallowing disorders that could be used to predict local recurrence or second primary malignancy among previously treated patients with HNSCC. Further, they assessed the application of transnasal esophagoscopy in this patient population.
The researchers identified patients treated for HNSCC with swallowing disorders who underwent transnasal esophagoscopy examinations between January 2010 and June 2014. They pathologically diagnosed local recurrence and second primary malignancies.
The study included data from 136 patients (mean age, 59 ± 12 years; 90% men). Seventy-seven percent of patients had advanced-stage (stage III or stage IV) HNSCC.
The researchers confirmed local recurrence in 32 patients and second primary malignancy in 14 patients, representing approximately 33% of the patient population. Simultaneous local recurrence and second primary malignancy occurred in one patient.
Among patients with second primary malignancy, 10 patients had tumors in the head and neck region and four patients had tumors in the esophagus.
No significant differences in age, sex, primary tumor location, stage and previous treatment modality occurred among patients with or without local recurrence or second primary malignancy. The positive predictive values for local recurrence or second primary malignancy were 38.24% for patients with odynophagia, 36.36% for easy choking, 30.99% for dysphagia, 28% for prolonged tube feeding and 25% for lumping throat.
Dysphagia served as the most frequent swallowing disorder among patients (n = 71; 52%). Other swallowing disorders included odynophagia (n = 34; 25%), prolonged tube feeding (n = 25; 18%) and easy choking (n = 22; 16%).
No significant difference existed between patients with or without local recurrence or second primary malignancy regarding swallowing disorders. The researchers could not determine an obvious index of symptoms and signs of swallowing disorders that significantly indicated local recurrence or second primary malignancy.
Further, the researchers did not observe any major complications after transnasal esophagoscopy, and they noted the procedure is the most effective method for inspecting for local recurrence or second primary malignancies.
The researchers acknowledged limitations of their study, including the study population’s sole inclusion of patients with swallowing disorders and the relatively small patient population.
“Direct inspection for local recurrence or second primary malignancy by using transnasal esophagoscopy is essential,” Chen and colleagues wrote. “The necessity and benefits of using transnasal esophagoscopy are crucial for patients treated for HNSCC, particularly for those with swallowing disorders.” – by Cameron Kelsall
Disclosure: The National Science Council of the Republic of China funded this study. HemOnc Today was unable to obtain a list of the researchers’ relevant financial disclosures at time of reporting.