Predictors of severe dysphagia following radiotherapy for head and neck cancer

Petersson, Kerstin; Finizia, Caterina; Tuomi, Lisa

doi:10.1002/lio2.676

Cited by 7 publications

(6 citation statements)

References 47 publications

(104 reference statements)

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“…Although the mechanism of this relationship is not well understood, other studies following radiotherapy for head and neck cancer have also demonstrated a correlation between higher BMI and decreased risk of severe dysphagia. 39 Finally, surgical factors such as free-flap reconstruction and NG tube dependence >3 weeks are predictive of future events of aspiration/penetration and may be early indications for more frequent SLP monitoring.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Cao

Shimunov

et al. 2023

The Laryngoscope

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ObjectivesTo describe swallowing and feeding‐tube outcomes in patients with high‐risk oropharyngeal cancer treated with trimodality therapy (TMT), including transoral robotic surgery (TORS) and adjuvant chemoradiotherapy.MethodsA chart review was conducted on patients with HPV+ OPSCC receiving TMT with TORS at an academic medical center from March 2010 to March 2021. Data collected included demographics, treatment, feeding tube placement, functional oral intake scale (FOIS) scores, and swallowing‐language pathology (SLP) evaluations.ResultsA total of 255 patients met selection criteria (mean age 61 years, 88% male). Following intraoperative nasogastric tube (NG) placement, 31% remained NG tube dependent after 3 weeks. A gastrostomy tube was placed in 19% of patients, and at 1 year after end‐of‐treatment (EOT), 3.5% overall remained tube‐dependent. Mean FOIS scores were 6.9 (SD = 0.3) at pre‐operative visit, 2.6 (1.8) at first post‐operative visit, and 5.5 (1.5) after EOT. In the subset of patients with follow‐up longer than 2 years (n = 118), the mean FOIS was 6.1 (SD = 1.3) at most recent visit. Clinical signs of aspiration/penetration were suspected on SLP evaluation in 18% of patients. These patients were subsequently evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) and/or barium swallow study, which confirmed signs of aspiration in 2.7% of patients overall. Delayed NG tube removal after 3 weeks was predictive of (1) gastrostomy tube requirement and (2) clinical signs of aspiration on an SLP visit after EOT.ConclusionsFavorable functional and feeding‐tube outcomes are demonstrated in patients with HPV‐associated OPSCC undergoing TMT. In this single‐institution study, we found low rates of long‐term feeding tube dependence and high median FOIS following treatment. Review of routine SLP visits provides a detailed and easily accessible means for assessing swallowing function in this cohort.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Cao

Shimunov

et al. 2023

The Laryngoscope

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“…A Likert 5-level scoring method was adopted; the responses “fully agree”, “agree”, “do not know”, “disagree”, and “completely disagree” were scored as 1, 2, 3, 4 or 5 points, respectively, and the total score was 20–100 points. A total score of less than 60 is defined as swallowing dysfuntion [ 23 ]. The higher the score, the better the patients rated their quality of life in terms of swallowing.…”

Section: Methodsmentioning

confidence: 99%

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

Liu,

Feng,

Liang

et al. 2024

Eur Arch Otorhinolaryngol

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Objective This study evaluated the swallowing and voice function of laryngeal cancer patients after Supracricoid Partial Laryngectomy(SCPL), and its influence on quality of life to provide a reference for the selection of surgical methods for laryngeal cancer patients. Methods Twenty-one patients who received SCPL between April 2015 and November 2021 were included. Each patient’s swallowing function and quality of life were assessed through fiberoptic endoscopic examination of swallowing (FEES) and the M.D. Anderson Dysphagia Inventory (MDADI). Fundamental, jitter, shimmer, maximum phonation time (MPT), and voice handicap index-10 (VHI-10) were performed to assess voice function and voice-related quality of life. Results The results of the FEES of the 21 patients were as follows: the rates of pharyngeal residue after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 38.09%, respectively; the rates of laryngeal infiltration after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 4.76%, respectively; and aspiration did not occur in any of the patients. In the evaluation of swallowing quality of life, the mean total MDADI score was 92.6 ± 6.32. The voice function evaluation showed that the mean F0, jitter, shimmer, and MPT values were 156.01 ± 120.87 (HZ), 11.57 ± 6.21 (%), 35.37 ± 14.16 (%) and 7.85 ± 6.08 (s), respectively. The mean total VHI-10 score was 7.14 ± 4.84. Conclusion SCPL provides patients with satisfactory swallowing and voice function. The patients in this study were satisfied with their quality of life in terms of swallowing and voice. SCPL can be used as a surgical method to preserve laryngeal function in patients with laryngeal cancer.

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“…In addition to acute mucositis, BMI < 22 was associated with late-stage dysphagia (Table 3). Overweight and increasing BMI predicted a lower risk of severe dysphagia after radiotherapy for head and neck cancer (19). Thus, swallowing training during/ after CCRT should be considered for patients with a low BMI to prevent post-CCRT dysphagia.…”

Section: Dysphagia Among Late Adverse Eventsmentioning

confidence: 99%

Chemoradiotherapy with 3-weekly CDDP 80 mg/m2 for head and neck squamous cell carcinoma: 5-year survival data from a phase 2 study

et al. 2022

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ObjectiveThe global standard for chemoradiation therapy (CCRT) for head and neck squamous cell carcinoma is cisplatin 100 mg/m2 administered once every three weeks, although cisplatin 80 mg/m2 is also widely used as an alternative treatment to reduce adverse events in Japan. We aimed to assess the long-term survival outcomes and late adverse events associated with CCRT with a 3-weekly cisplatin dose of 80 mg/m2.MethodsA phase 2 study on CCRT with a 3-weekly cisplatin dose of 80 mg/m2 was performed in 47 patients between April 2015 and December 2016 at four centers in Japan. Survival outcomes and late adverse events at 5 years after this phase 2 trial were investigated.ResultsThe median follow-up period was 61 months. The 5-year progression-free survival/overall survival of all 47 patients was 66.0%/76.6%, while that of patients with stage III, IV disease (UICC) was 65.6%/71.9%. Seventeen patients (36%) experienced dysphagia as a late adverse event. Univariate and multivariate analyses revealed a significant association between acute mucositis/low body mass index (BMI) during CCRT and late dysphagia.ConclusionThe survival outcomes of CCRT with a 3-weekly cisplatin dose of 80 mg/m2 may be comparable to the previously reported dose of 100 mg/m2. Acute mucositis and low BMI at CCRT were risk factors for late dysphagia, indicating the importance of managing these conditions during CCRT to prevent late adverse events. Caution and care for acute mucositis and swallowing training in patients with low BMI may be important for preventing late-stage dysphagia.

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Predictors of severe dysphagia following radiotherapy for head and neck cancer

Cited by 7 publications

References 47 publications

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

Chemoradiotherapy with 3-weekly CDDP 80 mg/m2 for head and neck squamous cell carcinoma: 5-year survival data from a phase 2 study

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