Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration‐related structures in patients with head and neck cancer undergoing definitive and postoperative intensity‐modulated radiotherapy

Abstract

Background The relationship between swallowing outcomes and radiotherapy dose to dysphagia and aspiration‐related structures (DARS) may be different following definitive versus postoperative radiotherapy (PORT) for mucosal head and neck cancer (HNC) and has not been well‐studied. Method Patient‐ and clinician‐reported swallowing measures were prospectively collected at six time points from baseline to 24 months postradiotherapy HNC. Radiotherapy plans were retrospectively analyzed to assess dose delivered to DARS. The association between swallowing outcomes and participant demographics, tumor characteristics, and radiotherapy dose in definitive and postoperative treatment cohorts was assessed. Results Ninety‐three participants who received radiotherapy for HNC were included in the analysis (n = 49 definitive radiotherapy for laryngeal/pharyngeal primary tumors and n = 44 postoperative PORT for predominantly oral cavity/salivary gland tumors). Participants undergoing PORT had lower doses to DARS than those undergoing definitive RT. High dose to the pharyngeal constrictors and base of tongue for definitive RT and the esophageal inlet, supraglottic larynx and cervical esophagus for the PORT group were associated with worse swallowing function. Conclusion Radiation dose to DARS is associated with post‐treatment swallowing outcomes. These dose/outcome relationships may vary between the definitive and postoperative settings.

Toxicities and clinical outcome of adjuvant dysphagia optimized versus standard intensity‐modulated radiotherapy for post‐operative oral cavity cancers: A prospective comparative study

“…The most debilitating adverse effects of head and neck radiotherapy are dysphagia and aspiration. There are many studies in literature evaluating the role of Do‐IMRT in head and neck cancer patients 18,24–34 . Most of these studies either had only pharyngeal carcinoma or the number of oral cavity carcinoma patients were very small.…”

“…There are many studies in literature evaluating the role of Do-IMRT in head and neck cancer patients. 18,[24][25][26][27][28][29][30][31][32][33][34] Most of these studies either had only pharyngeal carcinoma or the number of oral cavity carcinoma patients were very small. Charters et al had shown that there is a dose/outcome relationship for the dose of radiation received by DARS and dysphagia which may vary between definitive and post-op RT.…”

“…Charters et al had shown that there is a dose/outcome relationship for the dose of radiation received by DARS and dysphagia which may vary between definitive and post-op RT. 33 Different studies have identified different structures to be included in DARS. Eisbruch et al identified circular pharyngeal constrictors, longitudinal pharyngeal wall muscles, larynx (glottic and supraglottic) and its adductor muscles, supra-hyoid muscles (geniohyoid, mylohyoid, and digastric), and surfaces (mucosa and submucosa) of the base of tongue based on abnormalities seen after treatment and identifying anatomical structures whose malfunction will cause those abnormalities.…”

Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

“…Avoiding GI may be crucial in postradiation PGS in whom there is commonly an already impaired swallowing mechanism and therefore are more prone to aspirations. [28][29] Comparably, in post-intubation PGS patients there is often a pulmonary comorbidity and aspirations might result in devastating outcomes. The previously described techniques for correcting PGS generally have a high rate of GI symptoms.…”

“…The key rationale behind the DISCO protocol is to avoid the tradeoff between airway opening and GI symptoms. Avoiding GI may be crucial in post‐radiation PGS in whom there is commonly an already impaired swallowing mechanism and therefore are more prone to aspirations 28–29 . Comparably, in post‐intubation PGS patients there is often a pulmonary comorbidity and aspirations might result in devastating outcomes.…”