Structural Displacements During the Swallow in Patients with Early Laryngeal Cancers and Other Early Primary Cancers of the Head and Neck

Abstract

Spatial movement of pharyngeal structures involved in swallowing was assessed by videofluoroscopy in 24 patients with early (T1N0) carcinoma of the larynx prior to curative treatment using an identical radiotherapy regimen (55 Gy in 20 daily fractions), and in 24 patients who had early primary head and neck cancers in other locations that would not be expected to interfere with the pharyngeal swallowing process. There were no significant differences between the laryngeal cancer patients and the other patients. Measurements were generally consistent with previously reported results in volunteers with normal swallows. On univariate analysis, patients >or=70 vs. <70 years old had a significantly greater hyoid-laryngeal distance and pharyngeal area at rest. Patients with body mass index (BMI) >or=26 vs. <26 demonstrated a significantly greater maximal width of the pharyngo-oesophageal sphincter (PES) in the lateral view. Multiple regression revealed that greater hyoid-laryngeal distance at rest and at the point of maximal approximation were the significant predictors of male vs. female gender at the exclusion of all other variables, accounting for 59% of the variance. In no patient did contrast touch the vocal cords during the swallow. This study forms a baseline for future prospective evaluation of the effect of radiotherapy on the swallowing of patients with early laryngeal cancer.

The clinical value of dysphagia preassessment in the management of head and neck cancer patients

“…However, laryngeal penetration can occur in approximately a half of patients with early staged glottic cancer [22], despite other biomechanical measurements being within normal range. Again, we should note that penetration can occur as part of a healthy swallow [19].…”

Pharyngeal Swallowing Sound Profile Assessed after Partial and Total Laryngectomy

“…Before treatment, the efficiency of the swallowing function of a patient with head and neck cancer is often preserved. Ford et al [9] did not find any difference in spatial movements between a study population with early laryngeal cancer and normal subjects using videofluoroscopic analysis. In a pretreatment videofluoroscopic study, Pauloski et al [10] noted that patients with head and neck cancer demonstrated highly functional swallowing before treatment with a pharyngeal transit time that did not exceed 1 s. However, 41% of the patients complained of dysphagia, especially those with T3 and T4 lesions, where the pharyngeal transit time was significantly longer and pharyngeal residue was found in more than 70% of the patients.…”

Key changes in the future clinical application of ultra-high dose rate radiotherapy

“…Thermoplastics is a mature tool that ensures the relative consistency of a patient’s position during positioning and treatment ( 67 ). However, movement of internal organs during treatment, such as pharyngeal swallowing activity, respiratory movement, gastrointestinal motility and heartbeat, is an important factor affecting the accuracy of radiotherapy ( 68 – 70 ). Because of the long implementation time of SBRT (minutes to tens of minutes) ( 71 , 72 ), it is unlikely the movement of organs in the body near the target area can be avoided.…”