Dysphagia After Radiotherapy for Head and Neck Cancer: Etiology, Clinical Presentation, and Efficacy of Current Treatments

Abstract

After radiation therapy (RT) or chemoradiation (CRT) therapy for head and neck cancer, some patients develop significant swallowing problems. This complication is thought to be a result of radiation induced damage and chronic alteration of tissues whereby the body reacts to the radiation by producing fibrosis. In some persons, this healing process seems to go awry, thus causing excess fibrosis and dysphagia. The major problem faced by patients with dysphagia is stiffness of tissue and underlying muscle weakness, causing reduced bolus clearance; hence, food is much more problematic than liquids. In fact, aspiration is rare unless the dysphagia is severe. While compensatory treatment for dysphagia post C/RT is helpful, it is not rehabilitative. More permanent rehabilitative approaches use exercise regiments along with stretching. Massage, lymphedema therapy and electrical stimulation are sensory based or externally based treatments that also are employed, but less frequently. Unfortunately, the efficacy of most treatment approaches is limited, and randomized clinical trials urgently are needed to guide clinicians who work with this population.

Prophylactic Swallowing Exercises in Patients With Head and Neck Cancer Undergoing Chemoradiation<subtitle>A Randomized Trial</subtitle><alt-title>Prophylactic Exercises in HNC</alt-title>

“…Patients with HNC treated with CRT can present with progressive onset of fibrosis, whereby the edematous tissue caused by the radiation is replaced with stiffer fibrotic tissue. 34 For other patients, the fibrosis can occur years after the cancer treatment is completed. Either way, this fibrosis impairs the movement and coordination of the swallowing structures and results in the disruption of the efficient and effective bolus transport necessary for swallowing function.…”

Effects of 2 different swallowing exercise regimens during organ‐preservation therapies for head and neck cancers on swallowing function

“…The current literature suggests that dysphagia may develop either as a primary complication of head and neck tumors [13][14][15][16][17][18] or as a result of treatment with both surgical and nonsurgical interventions. 14,[19][20][21][22][23][24][25][26] RT is known to affect swallowing biomechanics in the short term through inflammation and edema and in the long term through fibrosis with scar tissue formation within irradiated structures. 24 Chemotherapy, while not affecting swallowing physiology or function in isolation, 27 is known to impair salivary function with resulting xerostomia.…”

“…14,[19][20][21][22][23][24][25][26] RT is known to affect swallowing biomechanics in the short term through inflammation and edema and in the long term through fibrosis with scar tissue formation within irradiated structures. 24 Chemotherapy, while not affecting swallowing physiology or function in isolation, 27 is known to impair salivary function with resulting xerostomia. This, in conjunction with painful oral mucositis, limits oral intake.…”

Strategies to reduce long‐term postchemoradiation dysphagia in patients with head and neck cancer: An evidence‐based review

“…Speech and language therapists recognize the importance of tailoring swallowing rehabilitation to the individual (often impossible to do in a clinical trial) both prior to and following treatment based on information acquired through detailed swallowing evaluation . In addition to exercise, it is important that the effect of other treatments are explored such as lymphedema therapy, massage, and stretching . Limitation of significant variables such as excluding patients who have undergone significant surgical resection is essential given the swallowing difficulties that may result.…”