Dysphagia after radiotherapy: State of the art and prevention

Servagi-Vernat, S.; Ali, David; Roubieu, C.; Durdux, C.; Laccourreye, O.; Giraud, P

doi:10.1016/j.anorl.2013.09.006

Cited by 34 publications

(21 citation statements)

References 50 publications

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“…In an earlier study among patients with OPC with advanced stage treated with concurrent RT and chemotherapy, feeding tube use had the maximum impact on QOL (−30 points compared to controls) evaluated by SF36 and HNQOL. 46 Late LCNP cases also had significantly higher rates of aspiration pneumonia (32.3% LCNP vs 2.0% no LCNP), which support association with high dysphagia-related morbidity. Similarly, a study using SEER data among patients with HNC treated with chemoradiation reported 23.8% 5-year rates of aspiration pneumonia.…”

Section: Discussionmentioning

confidence: 66%

“…High rates of gastrostomy dependence among LCNP cases again support a high prevalence of dysphagia in this population. In an earlier study among patients with OPC with advanced stage treated with concurrent RT and chemotherapy, feeding tube use had the maximum impact on QOL (−30 points compared to controls) evaluated by SF36 and HNQOL . Late LCNP cases also had significantly higher rates of aspiration pneumonia (32.3% LCNP vs 2.0% no LCNP), which support association with high dysphagia‐related morbidity.…”

Section: Discussionmentioning

confidence: 73%

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Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

et al. 2019

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Background The purpose of this study was to quantify the association of late lower cranial neuropathy (late LCNP) with swallowing‐related quality of life (QOL) and functional status among long‐term oropharyngeal cancer (OPC) survivors. Methods Eight hundred eighty‐nine OPC survivors (median survival time: 7 years) who received primary treatment at a single institution between January 2000 and December 2013 completed a cross‐sectional survey (56% response rate) that included the MD Anderson Dysphagia Inventory (MDADI) and self‐report of functional status. Late LCNP events ≥3 months after cancer therapy were abstracted from medical records. Multivariate models regressed MDADI scores on late LCNP status adjusting for clinical covariates. Results Overall, 4.0% (n = 36) of respondents developed late LCNP with median time to onset of 5.25 years post‐treatment. LCNP cases reported significantly worse mean composite MDADI (LCNP: 68.0 vs no LCNP: 80.2; P < .001). Late LCNP independently associated with worse mean composite MDADI (β = −6.7, P = .02; 95% confidence interval [CI], −12.0 to −1.3) as well as all MDADI domains after multivariate adjustment. LCNP cases were more likely to have a feeding tube at time of survey (odds ratio [OR] = 20.5; 95% CI, 8.6‐48.9), history of aspiration pneumonia (OR = 23.5; 95% CI, 9.6‐57.6), and tracheostomy (OR = 26.9; 95% CI, 6.0‐121.7). Conclusions In this large survey study, OPC survivors with late LCNP reported significantly poorer swallowing‐related QOL and had significantly higher likelihood of poor functional status. Further efforts are necessary to optimize swallowing outcomes to improve QOL in this subgroup of survivors.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 73%

Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

et al. 2019

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“…Bei 40 -80 % führt diese neben Mangelernährung zu Aspirationen. Im Rahmen eines multidisziplinären Ansatzes mit vor allem neuen Bestrahlungstechniken zur Präven-tion sowie rehabilitativ erlernten Schlucktechniken und adaptierter Kost kann man das Management optimieren [45]. In einer randomisierten kontrollierten Studie erhielten die Patienten zusätzlich Omega-3-Fettsäuren (EPA/DHA) im Rahmen der Gabe von 500 ml Supportan ® additiv zur normalen Standardernährung.…”

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Ernährungsprobleme unter Radiotherapie (RT) und Radiochemotherapie (RCT)

Bertz

Brunner

2016

Aktuel Ernahrungsmed

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Zusammenfassung Radio- und Radiochemotherapie sind die dritte Therapies?ule f?r zahlreiche Karzinome sowohl im kurativen und auch palliativen Therapiekonzept. Die Strahlentherapie f?hrt bei vielen Tumorpatienten, die h?ufig schon bei Erstdiagnose mangelern?hrt sind und durch die Tumorerkrankung nicht ausreichend essen k?nnen, zu weiteren ern?hrungsmedizinischen Problemen. Speziell Tumore im Hals-, Nasen-, Ohrenbereich sowie des ?sophagus geh?ren zu dieser Gruppe. Auch die Strahlentherapie der Lungenkarzinome beeinflusst das Gewebe des oberen Gastrointestinaltrakts mit Beeintr?chtigung der Nahrungsaufnahme. Der untere Gastrointestinaltrakt wird durch die Bestrahlung gyn?kologischer Tumore, das Rektum-, Anal-, Blasen- und Prostatakarzinom beeintr?chtigt mit der m?glichen Folge einer Radioenteritis. Durch neuere Techniken werden diese Nebenwirkungen immer geringer, sind aber vielf?ltig und bed?rfen eines interdisziplin?ren Behandlungskonzepts unter der Behandlung und in der Langzeitnachsorge. Prophylaxe und ern?hrungstherapeutische Therapien unter der Radiotherapie werden dargestellt, auch mit dem Schwerpunkt, ob die Ern?hrungstherapie zu einer Verbesserung des ?berlebens nach Strahlentherapie f?hrt. Die Nebenwirkungen akute und chronische Radioenteritis treten h?ufiger auf und werden ausf?hrlich bzgl. Prophylaxe, Therapie und Langzeitbetreuung dargestellt. Ern?hrungsmedizinische Diagnostik, Betreuung und Interventionen (mittels orale Trinknahrung, enteraler und parenteraler Ern?hrung) m?ssen fr?hzeitig in das multimodale Therapiekonzept dieser Tumore integriert werden. Nur so ist es m?glich, wie bei der Chemotherapie, Komplikationen zu vermeiden, das Tumoransprechen und speziell die Lebensqualit?t des Patienten zu verbessern.

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“…The extensive toxicities experienced by patients will be discussed in greater detail in Section Cohen et al, 2016;National Comprehensive Cancer Network, 2013;Schindler et al, 2015). There is a large evidence base supporting the benefit of SP involvement before, during and after (C)RT to optimise swallowing outcomes (Messing et al, 2019;Murphy & Gilbert, 2009;Russi et al, 2012;Servagi-Vernat et al, 2015;Wall, Cartmill, Ward, Hill, Isenring, & Porceddu, 2016). Speech pathology in HNC will be discussed in greater detail in section 1.4.…”

Section: Head and Neck Cancer Managementmentioning

confidence: 99%

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Moroney¹

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The management of head and neck cancer (HNC) using radiotherapy +/-chemotherapy (C)RT is associated with significant morbidity, due to key structures required for speech, swallowing, respiration, and voice falling within the treatment field. Common sequelae of non-surgical treatment include a wide range of toxicities, though dysphagia (swallowing difficulty) is particularly prominent. Dysphagia may be a short-term acute toxicity, or persist long-term, and can have a significant negative impact on quality of life. With recent advancements in technology, new conformal radiotherapy techniques such as helical intensity modulated radiotherapy (H-IMRT) have been introduced into clinical practice. Such techniques offer potential to limit the radiation exposure to non-cancerous normal tissues, and potentially reduce associated treatment toxicities -whilst maintaining cure rates. However as yet, there is limited literature documenting the incidence, severity, and pattern of treatment related toxicities, including dysphagia, associated with H-IMRT +/-chemotherapy, to support if such improvements for the patient are realised. Understanding how patients are impacted by new treatment approaches is crucial information for speech pathology services, that manage the dysphagia and related toxicities of patients. Therefore, the overall objective of this thesis was to evaluate the incidence and severity of dysphagia and related toxicities of patients undergoing H-IMRT +/-chemotherapy to inform speech pathology management practices. A secondary objective was to use this information to develop, and then evaluate a new clinical pathway of care. These objectives were addressed in a series of 4 studies.Study 1 (Chapter 2) prospectively examined the range of dysphagia and related toxicities from baseline to 12 weeks post H-IMRT +/-chemotherapy for a heterogeneous cohort of patients with mixed tumour sites and stages. A high proportion of patients were found to continue to experience grade 2-3 toxicity that peaked in the final week of treatment. Symptoms consistently improved thereafter, with the majority better than baseline by 12 weeks post-treatment.Concurrent chemotherapy at least doubled the odds of experiencing most symptoms. The findings of Chapter 2 confirmed that despite advancements in radiotherapy technique, patients iv The findings, clinical implications, limitations, and future areas of research are discussed in Chapter 6 of this thesis. In conclusion, this thesis provides information detailing the incidence, severity, and temporal pattern of dysphagia and related toxicities experienced by patients with HNC undergoing H-IMRT +/-chemotherapy to optimise supportive care and enhance patient education. These findings can be used to inform the timing and intensity of patient centred speech pathology service delivery models that meet the specific needs of patient subgroups and can form the basis of future guidelines for speech pathology support. v

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Dysphagia after radiotherapy: State of the art and prevention

Cited by 34 publications

References 50 publications

Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

Swallowing‐related outcomes associated with late lower cranial neuropathy in long‐term oropharyngeal cancer survivors: cross‐sectional survey analysis

Ernährungsprobleme unter Radiotherapie (RT) und Radiochemotherapie (RCT)

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

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