Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative RT. Patients treated with primary RT for HNC were candidates for this randomized protocol. Participants in the exercise group were instructed to perform swallowing exercises at home. Participants in the control group were given standard care. Patients were evaluated with modified barium swallow and several other secondary outcome measures at four and nine different time points, respectively. Data were analyzed according to intention-to-treat analyses. A total of 44 consecutive patients were included; 22 in each group. In general, there was no difference between the two groups regarding any of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence to exercises was a major issue and dropouts were frequent in both the intervention and control group.
Aspiration and aspiration pneumonia has been reported with a high incidence in head and neck cancer populations treated with chemo-radiotherapy. The aim of this study was to investigate the incidence and mortality of aspiration pneumonia in an unselected series of head and neck cancer patients treated with curative radiotherapy with or without concurrent weekly cisplatin. Material and methods. A total of 324 consecutive patients treated with curative intended radiotherapy for head and neck cancer in a single Danish referral center in Aarhus from 2006 to 2008 were included and followed for a median of 4.3 years. Data on patient, tumor and treatment characteristics were obtained from the DAHANCA database. Data on hospital admissions were obtained from the National Patient Registry. Data from the National Registry of Causes of Death were obtained on all deaths and causes of death. Results. Severe dysphagia occurred in 32% of the 324 patients included. A total of 18 patients developed aspiration pneumonia, corresponding to an incidence rate of 29 (95% CI 17-46) per 1000 person-years and an incidence proportion of 5.3% (95% CI 3.1-8.3%) in the fi rst year after radiotherapy; signifi cant risk factors included tube feeding, clinical stage, severe dysphagia and incomplete response to treatment. Three of the 18 patients with aspiration pneumonia died from this complication. Conclusion. Dysphagia-related aspiration and aspiration pneumonia are serious and potentially fatal treatment complications to accelerated radiotherapy, but occur less frequent than previously reported.
on behalf of the DAHANCA group (2013) Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer,
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