Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer

Lazarus, Cathy L.; Logemann, Jeri A.; Pauloski, Barbara Roa; Rademaker, Alfred; Helenowski, Irene; Vonesh, Edward F.; MacCracken, Ellen; Mittal, Bharat B.; Vokes, Everett E.; Haraf, Daniel J.

doi:10.1002/hed.20577

Cited by 98 publications

(99 citation statements)

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“…16 However, recovery may never be complete. We and others have previously reported that 8% to 20% of long-term survivors may become G-tube dependent.…”

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confidence: 99%

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

et al. 2009

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Objectives/Hypothesis:Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G‐tube).Methods:We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G‐tubes were placed as needed. The timing and duration of G‐tube placement and treatment‐related complications and risk factors for long‐term G‐tube use were analyzed.Results:A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy‐nine percent of patients received platinum‐based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G‐tube placement (15 prior to CRT and 21 during CRT). Median duration of G‐tube use was 5.8 months. Two patients who had a G‐tube placed during CRT developed a G‐tube‐related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G‐tubes, respectively. Patients with G‐tubes placed prior to CRT or advanced T stage had longer G‐tube dependence.Conclusions:With aggressive supportive care it is feasible to avoid G‐tubes in the majority of patients undergoing CRT for head and neck cancer. G‐tube placement prior to CRT due to pre‐existing dysphagia and advanced T stage are associated with prolonged G‐tube dependence. Laryngoscope, 2010

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“…16 However, recovery may never be complete. We and others have previously reported that 8% to 20% of long-term survivors may become G-tube dependent.…”

mentioning

confidence: 99%

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

et al. 2009

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“…In the CRT group there were statistical trends observed for more deficits in lingual control and increased aspiration risk on thin fluids, possibly due to the potential sequelae of the addition of chemotherapy to conventional radiotherapy. Late effects of CRT treatment have been reported to include chronic fibrosis resulting in stiffening of the tongue and hyolaryngeal complex [14], reduced glottic closure and oesophageal stenosis [34], that leads to significant oropharyngeal residue and aspiration. Indeed, a systematic review by van der Molen [35] found that chemoradiation regimens were associated with an increased aspiration rate, and this may result from the toxic effect on the neuromuscular junctions causing generalised weakness, fatigue, and sensory changes [36].…”

Section: Resultsmentioning

confidence: 99%

“…Although improving locoregional control and overall survival in [10], toxicity related to concurrent CRT regimens has been found to be significantly higher when compared to standard radiotherapy [1,11], and severe late swallowing complications have been found in 30-50% of patients treated with aggressive CRT regimens [4,11]. Reported dysphagia symptoms in HNC patients who received chemoradiotherapy regimens are diverse and have affected the oral phase [12][13][14], pharyngeal and upper esophageal phases of swallowing [12,13,15,16]. The impact on nutritional outcomes has been reported [5,12,15,[17][18][19], with several studies finding weight loss and nutritional compromise during and following radiotherapy and CRT protocols [20,21].…”

Section: Introductionmentioning

confidence: 99%

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Cartmill

Cornwell

Ward

et al. 2011

Support Care Cancer

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Purpose: Altered fractionation radiotherapy with concomitant boost (AFRT-CB) may be considered an alternative treatment for patients not appropriate for chemoradiation (CRT). As functional outcomes following AFRT-CB have been minimally reported, this exploratory paper describes the outcomes of patients managed with AFRT-CB or CRT at 6 months post treatment.Methods: Using a cross-sectional analysis design, functional outcomes of 14 AFRT-CB and 17 CRT patients with T1-T3 oropharyngeal cancers were explored at 6 months post-treatment. Clinical and instrumental swallow assessments, weight and nutritional status, and the functional impact of treatment were examined.Results: Inferior outcomes were observed for the CRT patients on the RBHOMS (p = 0.03) which was reflected in diet and fluid restrictions with 18% of the CRT group requiring modified fluids and diets.Although a trend (p = 0.07) was noted for increased lingual deficits and aspiration risk for fluids in the CRT group, no other significant differences were observed. Both groups experienced an average of 10kg weight loss and reported reduced general and swallowing related function. Conclusions:This preliminary data suggests functional outcomes following AFRT-CB and CRT were largely comparable at 6 months post treatment. Treatment intensification in any form may contribute to impaired function which requires multidimensional intervention. Larger cohort investigations with systematic methodology are needed to further examine these initial findings.Keywords: swallowing, nutrition, oropharyngeal cancer, chemoradiation, altered fractionation radiotherapy This paper aims to inform research by providing further evidence for functional outcomes following non-surgical treatment for head and neck cancer.

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“…2,9,[14][15][16][17] Decreased tongue mobility and strength, impairment in bolus preparation and transport, increased oral residue were described as oral phase disorders. 15,18,19 Delayed triggering swallowing reflex, impairment in velopharyngeal closure, decreased tongue base retraxion, pharyngeal contraction, hyolaryngeal elevation, airway closure, upper esophageal sphincter (UOS) opening and increased residue in tongue base, vallecula, pharynx and pyriform sinus were determined as phryngeal disorders after RT. 3,14,15,[20][21][22][23] In a study, decreased tongue base retraxion and hyolaryngeal elevation 1 month after CRT, delayed triggering swallowing reflex, impairment in airway closure 3 months after CRT, decreased UOS opening 6 and 12 months after CRT were found.…”

Section: Discussionmentioning

confidence: 99%

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

Selen¹

2013

UHOD

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The study aimed to show the changes on artrokinematic parameters of the neck and swallowing function after radiotherapy (RT) in head and neck cancer (HNC) patients. The fourty patients with HNC have been evaluated before, 1 and 3 months after RT. The posture, normal joint movement, muscle strength and endurance of the neck were evaluated as artrokinematic parameters. The clinical and radiological swallowing function evaluations were also done. Mean age of patients were 53,22±10,92 years. Head anterior tilt, kyphosis and shoulder protraction were more in the 3rd month after RT in posture analysis (p< 0.001). The neck flexion, lateral flexion and rotation limitations have increased (p< 0.001), neck muscle strength and endurance have gradually decreased (p< 0,001) after RT. At the same time, swallowing phases have been adversely affected after RT with all these side effects (p< 0.001) and the severity of aspiration in all consistencies has increased gradually (p< 0.05). As a result, RT starts to show its negative effects from the early period of cancer treatment. Unlike other studies, we concluded that RT affects head and neck structures negatively and these describes how RT affects swallowing function. So it is highly important to include head and neck structure mobility, strength and endurance assessments and exercises in swallowing rehabilitation.Keywords: Head and neck cancer, Radiotherapy, Swallowing, Neck structures, Dysphagia ÖZET Bafl Boyun Kanseri: Radyoterapi Sonras› Boyun Artrokinematik Parametreleri ve Yutma Fonksiyonundaki De¤iflikliklerÇal›flman›n amac›; bafl boyun kanserli (BBK) hastalarda radyoterapi (RT) sonras› boyun artrokinematik parametreleri ve yutma fonksiyonundaki de¤ifliklikleri göstermektir. BBK'l› 40 hasta RT öncesi, sonras› 1 ve 3. aylarda de¤erlendirildi. Artrokinematik parametreler olarak boyun postür, normal eklem hareketi, kas kuvvet ve endurans› de¤erlendirildi. Klinik ve radyolojik yutma fonksiyon de¤er-lendirmeleri de yap›ld›. Hastalar›n yafl ortalamas› 53,22±10,92 y›ld›. Postür analizinde bafl anterior tilti, kifoz ve omuz protraksiyonu RT sonras› 3. ayda daha fazla idi (p< 0.001). RT sonras› boyun fleksiyon, lateral fleksiyon ve rotasyon limitasyonlar› artt› (p< 0.001), boyun kas kuvvet ve endurans› giderek azald› (p< 0.001). Ayn› zamanda RT sonras› tüm bu yan etkilerle birlikte yutma fazlar› kötü yönde etkilendi (p< 0.001) ve tüm k›vamlarda aspirasyon fliddeti giderek artt› (p< 0.05). Sonuç olarak RT erken dönemden itibaren olumsuz etkilerini göstermeye bafllamaktad›r. Di¤er çal›flmalardan farkl› olarak RT'nin bafl ve boyun yap›lar›n› olumsuz yönde etkiledi¤i ortaya konuldu ve bu da RT'nin yutma fonksiyonunu nas›l etkiledi¤i aç›klamaktad›r. Bu yüzden yutma rehabilitasyonuna bafl boyun yap› hareketlilik, kuvvet ve endurans de¤erlendirme ve egzersizlerini dahil etmek çok önemlidir.

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Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer

Abstract: Parallel but not significant changes in oral intake, diet, and tongue strength in the first year post chemoradiation therapy need further study in a larger population.

Cited by 98 publications

References 22 publications

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

Swallowing, nutrition and patient-rated functional outcomes at 6 months following two non-surgical treatments for T1–T3 oropharyngeal cancer

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

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