Objective Proactive swallowing therapy promotes ongoing use of the swallowing mechanism during radiotherapy through 2 goals: eat and exercise. The purpose of this study was to evaluate the independent effects of maintaining oral intake throughout treatment and preventive swallowing exercise. Design Retrospective observational study. Setting The University of Texas MD Anderson Cancer Center, Houston. Patients The study included 497 patients treated with definitive radiotherapy (RT) or chemoradiation (CRT) for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008. Main Outcome Measures Swallowing-related endpoints were: final diet after RT/CRT and length of gastrostomy-dependence. Primary independent variables included per oral (PO) status at the end of RT/CRT (nothing per oral [NPO], partial PO, 100% PO) and swallowing exercise adherence. Multiple linear regression and ordered logistic regression models were analyzed. Results At the conclusion of RT/CRT, 131 (26%) were NPO, 74% were PO (167 [34%] partial, 199 [40%] full). Fifty-eight percent (286/497) reported adherence to swallowing exercises. Maintenance of PO intake during RT/CRT and swallowing exercise adherence were independently associated (p<0.05) with better long-term diet after RT/CRT and shorter length of gastrostomy dependence in models adjusted for tumor and treatment burden. Conclusions Data indicate independent, positive associations between maintenance of PO intake throughout RT/CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest return to a regular diet and shortest gastrostomy dependence.

Almost 40% of patients with oropharyngeal cancer treated with nonsurgical organ preservation modalities may avoid feeding tube placement. Factors that predispose to g-tube placement and prolonged dependence include T3 to T4 tumors, concurrent chemotherapy, current smoking status, and baseline swallowing dysfunction or weight loss. Adherence to an aggressive swallowing regimen may reduce long-term dependence on enteral nutrition and limit the rate of g-tube placement overall.

BACKGROUND: Adenoid cystic carcinoma (ACC) is characterized by slow growth, frequent local recurrences, and distant metastasis (DM). However, these findings frequently are reported in patients with advancedstage tumors, but the outcomes of early-stage tumors are poorly defined. We sought to evaluate the risk factors for the development of DM in early-stage ACC. METHODS: We retrospectively reviewed the charts of 60 patients who were diagnosed with clinical early-stage (T1-2/N0) ACC to determine the risk factors for development of DM and survival of these patients. RESULTS: DM was detected in 12 (20%) of the patients, with a median latency of 31.5 months after diagnosis. Univariate analysis revealed that DM was associated with age !45 years, pathologically positive lymph nodes, extracapsular spread (ECS) from lymph nodes, high-grade histology, and solid tumor subtype. Multivariate analysis revealed solid tumor subtype and ECS to be significantly associated with DM. Disease-specific survival rates at 5 and 10 years for patients with DM were 80% and 40%, respectively, and were both 100% for patients without DM. CONCLUSION: Although the majority of patients with clinical early-stage ACC of the major salivary glands have favorable prognosis, a significant percentage of patients will develop DM. Solid tumor subtype and nodal ECS were independent predictors of DM in early-stage ACC of major salivary glands. Other clinical and pathological variables may also contribute. These subgroups had poor overall and disease-specific survival. Such patients should be observed closely for the development of DM. Systemic therapy should be considered at the time of diagnosis.

Background The aim of the study was to examine prevalence of dysphagia at the population level in head and neck cancer (HNC) survivors. Methods Surveillance, Epidemiology, and End Results‐Medicare claims among 16 194 patients with HNC (2002‐2011) were analyzed to estimate 2‐year prevalence of dysphagia, stricture, and aspiration pneumonia, and derive treatment‐ and site‐specific estimates. Results Prevalence of dysphagia, stricture, pneumonia, and aspiration pneumonia was 45.3% (95% confidence interval [CI]: 44.5‐46.1), 10.2% (95% CI: 9.7‐10.7), 26.3% (95% CI: 25.6‐26.9), and 8.6% (95% CI: 8.2‐9.1), respectively. Dysphagia increased by 11.7% over the 10‐year period (P < .001). Prevalence was highest after chemoradiation and multimodality therapy. Conclusion Comparing to published rates using similar methodology the preceding decade (1992‐1999), prevalence of dysphagia based on claims data was similar in 2002‐2011 in this study. These results suggest persistence of dysphagia as a highly prevalent morbidity, even in the decade in which highly conformal radiotherapy and minimally invasive surgeries were popularized.