Outcomes of Combined Antegrade-Retrograde Dilations for Radiation-Induced Esophageal Strictures in Head and Neck Cancer Patients

Severe Refractory Post-Radiation Strictures: Lessons Learned from Long-term Follow-up after Combined Antegrade Retrograde Dilation

PURPOSE OF REVIEW

Dysphagia with an identifiable stricture occurs frequently following chemoradiation therapy for head/neck cancer patients, some developing complete obliteration of the esophageal lumen. Combined Antegrade Retrograde Dilation (CARD) is designed to restore luminal patency. This paper reports how experience at one institution shaped a more effective strategy for the long-term management of this difficult patient population.

RECENT FINDINGS

Twenty patients, mean age 62.6 years, initially undergoing CARD procedure, subsequently required a total of 278 dilation sessions (average 13.9 sessions/patient) performed on average every 8.2 weeks (range 2.7-12.6). All patients achieved luminal patency. Complications occurred in 7 patients (35.0% of patients, 2.5% of all procedures) and included traumatic bleeding, pneumothorax, overt esophageal perforation, microscopic perforation with cervical osteomyelitis, and perforation at the gastrostomy site. Diet and dysphagia scores were ineffective at directing the schedule for maintenance dilation. The CARD procedure is effective at restoring initial esophageal patency, but must be followed closely with long-term maintenance dilation. Over a large number of dilations, complications are infrequent and difficult to predict. Their incidence may be reduced by use of prophylactic antibiotics, prior removal of a tracheoesophageal prosthesis, avoiding dilation of the gastrostomy tract, modest dilation goal, and scheduled "stricture surveillance" with dilations performed under fluoroscopic guidance.

Improved functional oral intake and exercise training attenuate decline in aerobic capacity following chemoradiotherapy in patients with esophageal cancer

PURPOSE

To investigate the impact of chemoradiotherapy on the physical fitness of patients with oesophageal cancer, and the clinical factors influencing it.

METHOD

A total of 67 participants successfully completed the study, with 18 of them engaging in supervised, in-hospital aerobic training at moderate intensity for a minimum of 20 sessions. Cardiopulmonary exercise testing, hand grip strength, body composition assessed via bioelectrical impedance analysis, patient-generated subjective global assessment, albumin, and the Functional Oral Intake Scale (FOIS) were evaluated before chemoradiotherapy and 6-8 weeks after its completion.

RESULT

Among the participants, cardiopulmonary fitness, hand grip strength, and phase angle of BC-BIA declined during chemoradiotherapy. Before and after chemoradiotherapy, V̇O2peak was 19.6 ± 4.4 and 17.4 ± 3.9 mL/min/kg respectively. The improvement in FOIS during chemoradiotherapy showed a positive correlation with changes in aerobic capacity. Additionally, exercise training was associated with attenuating the decline in aerobic capacity.

CONCLUSION

Physical fitness deteriorated in patients with oesophageal cancer following chemoradiotherapy. Improvement in dysphagia helps maintain aerobic capacity. Additionally, exercise training has the potential to mitigate the decline. This discovery can serve as a reference for enhancing holistic care for patients with oesophageal cancer.

Neopharyngeal Stricture following Laryngectomy

Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.