Oro‐pharyngo‐esophageal radionuclide scintigraphy predicts aspiration pneumonia risk and associated survival in post‐irradiated nasopharyngeal carcinoma patients

Abstract

Objective: To demonstrate that oro-pharyngo-esophageal radionuclide scintigraphy (OPERS) not only detects tracheobronchial aspiration after swallowing, but also quantifies the amount of aspiration and subsequent clearance.Methods: Data collected between 2014 and 2019 were reviewed for aspiration pneumonia at 12 and 24-months after OPERS. The predictive value for aspiration pneumonia on flexible endoscopic evaluation of swallowing (FEES), videofluoroscopic swallowing study (VFSS), and OPERS, and the overall survival of patients with or without aspiration were determined.Results: Thirty-seven patients treated with radiotherapy for nasopharyngeal carcinoma (NPC) were reviewed. The incidence of aspiration detected on FEES, VFSS, and OPERS was 78.4%, 66.7%, and 44.4%, respectively. Using VFSS as a gold standard, the sensitivity and specificity of OPERS for aspiration was 73.7% and 100%.The positive and negative predictive values for aspiration were 100% and 66.7%, respectively, with an overall accuracy of 82.8%. A history of aspiration pneumonia was one factor associated with a higher chance of subsequent aspiration pneumonia within 12 months (odds ratio: 15.5, 95% CI 1.67-145.8, p < .05) and 24 months (odds ratio: 23.8, 95% CI 3.69-152.89, p < .01) of the swallowing assessment. Aspiration detected by OPERS was a significant risk factor for future aspiration pneumonia at 12 and 24 months respectively. Significantly, better survival was associated with an absence of aspiration on OPERS only, but not on FEES or VFSS.

The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma

“…[11][12][13] Micro-aspiration of gastric refluxate into the upper and lower airway in gastroesophageal reflux disease (GERD) has been demonstrated using gastroesophageal scintigraphy. 14,15 While aspiration is a long-term sequela of radiotherapy for NPC, commonly due to oropharyngeal dysphagia as shown by previous studies, [16][17][18][19] there are few studies investigating the prevalence of GERD and laryngopharyngeal reflux (LPR) in patients with head and neck cancer after radiotherapy or chemoradiotherapy, and their possible relationship with dysphagia and subsequent pulmonary complications. We aimed to determine the incidence of aspiration pneumonia in patients with NPC, which may be as high as 83.9%, whereas silent aspiration may vary from 42% to 66% in patients with dysphagia after head and neck radiotherapy or chemoradiotherapy.…”