Objective Assessment of Swallowing Function After Definitive Concurrent (Chemo)radiotherapy in Patients with Head and Neck Cancer

Abstract

The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration-aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n = 34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P = 0.05), and large tumor volume (P = 0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.

RETRACTED: Laryngeal Function After Radiation Therapy

“…58 In contrast, studies that reported rates of symptomatic and asymptomatic aspiration with instrumental swallowing evaluations report higher aspiration rates of 30% to 62%. 59,60 Stricture An important contributor to dysphagia after CRT for HNC is pharyngoesophageal stricture. Stricture is not as common as physiologic impairments that reduce the range of motion of swallowing structures; however, when it develops it can greatly impact the swallowing function and lead to prolonged feeding tube dependence.…”

Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer

“…The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies. Head and neck cancer (HNC) can have a profound impact on swallowing function [1][2][3][4][5]. The treatment of these patients with radiotherapy (RT), chemoradiation (CRT) or radiotherapy plus cetuximab (CetRT) may further affect swallowing function, eventually leading to tube feeding dependence.…”

Oropharyngeale Dysphagien - ein Update Teil 2: Ätiologie und Therapie

“…Diese Tendenz untermauert auch eine Studie von Agarwal und Kollegen, die anhand einer Untersuchung von 47 Patienten mit einem fortgeschrittenen Tumor des Kopf-Hals-Bereiches, bei denen eine kurative Radiochemotherapie durchgeführt wurde. Ein modifi zierter Bariumschluck zeigte nach 6 Monaten eine signifi kante Verschlechterung des Schluckens mit Zunahme an pharyngealen Residuen aufgrund einer Bolustransportstörung sowie eine erhöhten Aspirationsneigung [ 32 ] . Neben Sensibilität-und Motilitätsstörungen ist hier auch eine postradiogen reduzierte Larynxelevation ursächlich.…”