Impact of selective neck dissection on chronic dysphagia after chemo-intensity-modulated radiotherapy for oropharyngeal carcinoma

Background. Conflicting results are reported regarding the impact of neck dissection on radiation-associated dysphagia. The purpose of this study was to reexamine this question specific to oropharyngeal intensity-modulated radiotherapy (IMRT). Methods. Three hundred forty-nine patients with oropharyngeal cancer treated with bilateral IMRT with systemic therapy (induction and/or concurrent) were reviewed. Chronic dysphagia was defined by aspiration, stricture, pneumonia, and/or gastrostomy dependence >12 months post-IMRT. Results. Selective neck dissection was performed after IMRT in 75 patients (21%). Overall, 41 patients (12%) developed chronic dysphagia. Neck dissection did not increase the rate of chronic dysphagia (9% neck dissection; 12% no neck dissection; p=.464) or gastrostomy duration (p=.482). On multivariate analysis, age (odds ratio [OR] per 5-year51.25; 95% confidence interval [CI] 51.04-1.51), baseline abnormal diet (OR=2.78; 95% CI=1.31-5.88), and IMRT dose (OR per 5-Gy=5.11; 95% CI=1.77-14.81) significantly predicted dysphagia. Conclusion. In the setting of selective neck dissection for residual adenopathy after IMRT, neck dissection did not impact dysphagia. (C) 2015 Wiley Periodicals, Inc.