Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation

Abstract

The aim of this study was to investigate the prevalence, severity, and pattern of evolution of swallowing impairments encountered in head and neck cancer (HNC) patients before and after chemoradiation (CRT) with videofluoroscopy of swallowing study (VFSS), using the modified barium swallow impairment profile (MBSImP) protocol and scoring system, and to determine the appropriate time points in which these patients should undergo VFSS post-CRT. A prospective cohort of 69 patients with locally advanced HNC underwent VFSS with the MBSImP protocol at 5 evaluation points: pre-CRT, and 1, 3, 6, and 12 months post-CRT. VFSS was scored with MBSImP, penetration-aspiration scale (PAS), and swallowing performance status (SPS) scale. Statistical analysis was performed only for the 12-month disease-free subset of patients. MBSImP, PAS, and SPS scale scores reached their peak at 3 months post-CRT and improved at 6-12 months, but without returning at pre-treatment levels. Base of tongue retraction, initiation of pharyngeal swallow, epiglottic movement, laryngeal vestibule closure, and laryngeal elevation were the most frequently observed impaired MBSImP components. Epiglottic movement significantly improved (p = 0.009) and laryngeal vestibule closure significantly deteriorated (p = 0.042) over time (Friedman test). Severe swallowing deficits and high aspiration rates are observed in HNC patients pre-CRT, which further deteriorate post-CRT, peak at 3 months, and despite slight improvement, persist over time. We suggest that these patients, regardless of the presence of subjective dysphagia, should undergo VFSS both before and 3 months post-CRT, and also if possible, 1 month post-CRT, in order to facilitate implementation of early swallowing rehabilitation.

EAT‐10 Scores and Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients

“…12,13 The high prevalence of OD and its consequences on health-related quality of life in this population asks for early detection of this condition in order to facilitate early implementation of swallowing rehabilitation and nutritional support. [14][15][16] Often, it remains unclear which patients should be monitored for OD and at what time points. 17 It can be expected that fewer complications of OD will arise if the nature of OD and the nutrition status are systematically monitored during the HNC follow-up visits.…”

Effect of tongue‐strengthening exercises on tongue strength and swallowing‐related parameters in chronic radiation‐associated dysphagia

“…14,15 It was confirmed that RAD is characterized by deviations in the base of the tongue, laryngeal vestibule closure, laryngeal elevation, and aspiration. 16,17 A possible explanation for reduced TS may be the changed structure of the tongue. As the tongue consists of types I and II muscle fibers, 18 with type II muscle fibers being sensitive to early RT injury, 9 it can be assumed that TS will be affected by RT.…”

Videofluoroscopic Evaluation of the Pharynx and Upper Esophageal Sphincter in the Dog: A Systematic Review of the Literature

“…Review of the literature and personal consultation with a specialist in otolaryngology indicates that there is no consensus regarding a protocol for performing VFSS in people with dysphagia (personal communication with Peter Belafsky MD, PhD, Medical Director of the Voice and Swallowing Center University of California, Davis). Unalike protocols are reported by different institutions in the United States currently publishing in this area of research (23–25) although protocol consensus may be consistent loco-regionally or in different countries. The method for assessment of VFSS studies is also not standardized in people despite the fact that a comprehensive set of quantitative measures have been developed, reported and validated (26).…”