Silent aspiration and swallowing physiology after radiotherapy in patients with nasopharyngeal carcinoma

Ng, Louisa K.Y.; Lee, Kathy; Chiu, Sung Nok; Ku, Peter K. M.; Hasselt, C. Andrew van; Tong, Michael C. F.

doi:10.1002/hed.21627

Cited by 26 publications

(28 citation statements)

References 16 publications

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“…The clinical significance of this criterion is that it can prevent radiation oncologists from prescribing RT doses greater than 60 Gy for negative LRPL nodes, and it is more straightforward than an MIAD ranging from 5.0 to 5.9 mm. Excessive RT doses, especially 66 to 70 Gy, cause a higher incidence of complications such as internal carotid artery injury [ 24 ] and swallowing dysfunction [ 25 ] and more severe dryness of mouth [ 26 – 28 ]. If a LRPL node is the only node with suspected involvement, our criteria can prevent patients from undergoing unnecessary chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Can Parameters Other than Minimal Axial Diameter in MRI and PET/CT Further Improve Diagnostic Accuracy for Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Wang

Zhang

et al. 2016

PLoS ONE

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PurposeMinimal axial diameter (MIAD) in magnetic resonance imaging (MRI) was recognized as the most useful parameter in diagnosing lateral retropharyngeal lymph (LRPL) nodes in nasopharyngeal carcinoma (NPC). This study aims to explore the additional nodal parameters in MRI and positron emission tomography–computed tomography for increasing the prediction accuracy.Materials and MethodsA total of 663 LRPL nodes were retrospectively collected from 335 patients with NPC. The LRPL nodes ascertained on follow-up MRI were considered positive for metastases. First, the optimal cutoff value of each parameter was derived for each parameter. In addition, neural network (NN) nodal evaluation was tested for all combinations of three parameters, namely MIAD, maximal axial diameter (MAAD), and maximal coronal diameter (MACD). The optimal approach was determined through brute force attack, and the results of two methods were compared using a bootstrap sampling method. Second, the mean standard uptake value (NSUVmean) was added as the fourth parameter and tested in the same manner for 410 nodes in 219 patients.ResultsIn first and second analysis, the accuracy rate (percentage) for the MIAD was 89.0% (590/663) and 89.0% (365/410), with the optimal cutoff values being 6.1 mm and 6.0 mm, respectively. With the combination of all three and four parameters, the accuracy rate of the NN was 89% (288/332) and 88.8% (182/205), respectively. In prediction, the optimal combinations of the three and four parameters resulted in correct identification of three (accuracy: 593/663, 89.4%) and six additional nodes (371/410, 90.5%), representing 4% (3/73) and 13.3% (6/45) decreases in incorrect prediction, respectively.ConclusionNPC LRPL nodes with an MIAD ≥ 6.1 mm are positive. Among nodes with an MIAD < 6.1 mm, if the NSUVmean ≥ 2.6 or MACD ≥ 25 mm and MAAD ≥ 8 mm, the nodes are positive; otherwise, they are negative.

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Section: Discussionmentioning

confidence: 99%

Can Parameters Other than Minimal Axial Diameter in MRI and PET/CT Further Improve Diagnostic Accuracy for Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Wang

Zhang

et al. 2016

PLoS ONE

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“…The clinical significance of this criterion is that it can prevent radiation oncologists from prescribing RT doses greater than 60 Gy for negative LRPL nodes, and it is more straightforward than an MIAD ranging from 5.0 to 5.9 mm. Excessive RT doses, especially 66 to 70 Gy, cause a higher incidence of complications such as internal carotid artery injury [24] and swallowing dysfunction [25] and more severe dryness of mouth [26][27][28]. If a LRPL node is the only node with suspected involvement, our criteria can prevent patients from undergoing unnecessary chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Can Parameters Other Than Minimal Axial Diameter in MRI and PET/CT Further Improve the Diagnostic Accuracy of Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Wang

Lin

Chang

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…In particular, the physical changes induced by radiation, including lymphedema, fibrosis, atrophy, and neuropathy, [19][20][21] were more pronounced in the patients treated for nasopharyngeal carcinoma, who were the majority of our patients. 22 Although intensitymodulated radiotherapy may delay the onset of these complications, it does not eliminate them. 23 Various partial and total laryngeal closure techniques have been reported for the control of chronic aspiration.…”

Section: Discussionmentioning

confidence: 99%

Tubed Supraglottic Laryngeal Closure to Treat Chronic Aspiration After Radiotherapy for Head and Neck Cancer

Vlantis

Cho

et al. 2020

The Laryngoscope

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Objectives/Hypothesis: To evaluate the long-term swallowing outcomes after surgical treatment for chronic aspiration in patients treated with radiotherapy for head and neck cancer. Study Design: This was a retrospective study. Methods: The data of patients who underwent radiotherapy for head and neck cancer and who subsequently required a laryngectomy or a tubed supraglottic laryngeal closure (TSLC) for recurrent aspiration pneumonia between 2004 and 2017 were retrieved from a tertiary referral hospital dysphagia clinic. The Functional Oral Intake Scale (FOIS) and the Swallowing Performance and Status Scale (SPSS) were used to assess swallowing function. Results: Of the 17 patients who required surgery for chronic aspiration secondary to radiotherapy for head and neck cancer, two underwent a laryngectomy and 15 a TSLC. During a mean follow-up of 77 months, the FOIS and SPSS scores significantly improved at 12, 24, and 36 months after laryngectomy and TSLC relative to the baseline (P < .05). Both patients who underwent laryngectomy and 11 of the 15 (73.3%) who underwent a TSLC resumed oral feeding. Both laryngectomy patients had episodes of recurrent aspiration pneumonia after surgery due to leakage through the tracheoesophageal puncture or prosthesis, whereas none of the TSLC patients had these episodes. Conclusion: A tubed supraglottic laryngeal closure, which is a reversible procedure that preserves the larynx and allows for natural phonation, should be considered an alternative to laryngectomy for the control of chronic aspiration.

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Silent aspiration and swallowing physiology after radiotherapy in patients with nasopharyngeal carcinoma

Abstract: Silent aspiration of thin fluids is a common occurrence in dysphagic NPC post-RT, with least aspiration noted on soft diet. Considering the high incidence of silent aspiration, instrumental assessment in this cohort is crucial.

Cited by 26 publications

References 16 publications

Can Parameters Other than Minimal Axial Diameter in MRI and PET/CT Further Improve Diagnostic Accuracy for Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Can Parameters Other than Minimal Axial Diameter in MRI and PET/CT Further Improve Diagnostic Accuracy for Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Can Parameters Other Than Minimal Axial Diameter in MRI and PET/CT Further Improve the Diagnostic Accuracy of Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma?

Tubed Supraglottic Laryngeal Closure to Treat Chronic Aspiration After Radiotherapy for Head and Neck Cancer

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