Swallowing disorders in the first year after radiation and chemoradiation

Logemann, Jeri A.; Pauloski, Barbara Roa; Rademaker, Alfred; Lazarus, Cathy L.; Gaziano, Joy; Stachowiak, Linda; Newman, Lisa A.; MacCracken, Ellen; Santa, Daphne; Mittal, Bharat B.

doi:10.1002/hed.20672

Cited by 186 publications

(192 citation statements)

References 12 publications

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“…Persistent deficits in swallowing physiology occurred in four physiological parameters from 4-6 weeks to 6 months post-treatment, indicating that if there was no improvement in the period immediately following treatment, participants experienced impairment in that parameter for at least 6 months post-treatment, similar to findings in the chemoradiation literature 15,36,37 . Impairments of palatal closure, position of the bolus at the onset of the swallow, and laryngeal excursion have been found in the early post-treatment phase in chemoradiation patients with little functional improvement by 12 months post-treatment 30, 58, 60 , and findings from the current study may suggest AFRT-CB causes similar long-term functional impairment.…”

Section: Six Months Post-treatmentsupporting

confidence: 66%

“…There is no consensus on data reduction in VFS with some studies rating the first swallow 33 , rating the average performance across two or three swallows [34][35][36] , or giving no comment on the data analysis 37,38 . In the current study, the worst performance observed across the food and fluid trials was used for analysis.…”

Section: Swallow Functionmentioning

confidence: 99%

“…Such changes have been attributed to chronic fibrotic changes affecting function of salivary glands, and range of movement of musculature and cartilage/bone 12,30,[67][68][69][70][71][72] . Trismus and xerostomia are common post radiotherapy side effects for patients with head and neck cancer, and can deleteriously affect the ability to chew solid foods, manipulate solid boluses and prepare cohesive boluses ready for swallowing 70,71 .…”

Section: Six Months Post-treatmentmentioning

confidence: 99%

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A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

et al. 2011

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Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal SCC has not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition and patient-perceived functional impact assessments were conducted pre-treatment, at 4-6 weeks post-treatment and at 6 months posttreatment. Deterioration from pre-treatment to 4-6 weeks post-treatment in swallowing, nutrition and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing and overall function, consistent with recovery from acute toxicity. However, weight and patient-perception of their physical function and side effects remained significantly worse than pre-treatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

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Section: Six Months Post-treatmentsupporting

confidence: 66%

Section: Swallow Functionmentioning

confidence: 99%

Section: Six Months Post-treatmentmentioning

confidence: 99%

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A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

et al. 2011

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“…2,9,[14][15][16][17] Decreased tongue mobility and strength, impairment in bolus preparation and transport, increased oral residue were described as oral phase disorders. 15,18,19 Delayed triggering swallowing reflex, impairment in velopharyngeal closure, decreased tongue base retraxion, pharyngeal contraction, hyolaryngeal elevation, airway closure, upper esophageal sphincter (UOS) opening and increased residue in tongue base, vallecula, pharynx and pyriform sinus were determined as phryngeal disorders after RT.…”

Section: Discussionmentioning

confidence: 99%

“…3 The effects of RT on mobility and strength of oropharyngeal structures were demonstrated in previous studies. [4][5][6][7][8][9][10] Optimal rehabilitation programme includes not only oropharyngeal exercises which are focus on oropharyngeal mobility and strength but also neck mobility and strengthening exercises. Although we know the importance of head and neck structures mobility and strength in swallowing rehabilitation, there is no study to evaluate the artrokinematic characteristics of head and neck like posture, range of motion, strength and endurance after RT.…”

Section: Introductionmentioning

confidence: 99%

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

Selen¹

2013

UHOD

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The study aimed to show the changes on artrokinematic parameters of the neck and swallowing function after radiotherapy (RT) in head and neck cancer (HNC) patients. The fourty patients with HNC have been evaluated before, 1 and 3 months after RT. The posture, normal joint movement, muscle strength and endurance of the neck were evaluated as artrokinematic parameters. The clinical and radiological swallowing function evaluations were also done. Mean age of patients were 53,22±10,92 years. Head anterior tilt, kyphosis and shoulder protraction were more in the 3rd month after RT in posture analysis (p< 0.001). The neck flexion, lateral flexion and rotation limitations have increased (p< 0.001), neck muscle strength and endurance have gradually decreased (p< 0,001) after RT. At the same time, swallowing phases have been adversely affected after RT with all these side effects (p< 0.001) and the severity of aspiration in all consistencies has increased gradually (p< 0.05). As a result, RT starts to show its negative effects from the early period of cancer treatment. Unlike other studies, we concluded that RT affects head and neck structures negatively and these describes how RT affects swallowing function. So it is highly important to include head and neck structure mobility, strength and endurance assessments and exercises in swallowing rehabilitation.Keywords: Head and neck cancer, Radiotherapy, Swallowing, Neck structures, Dysphagia ÖZET Bafl Boyun Kanseri: Radyoterapi Sonras› Boyun Artrokinematik Parametreleri ve Yutma Fonksiyonundaki De¤iflikliklerÇal›flman›n amac›; bafl boyun kanserli (BBK) hastalarda radyoterapi (RT) sonras› boyun artrokinematik parametreleri ve yutma fonksiyonundaki de¤ifliklikleri göstermektir. BBK'l› 40 hasta RT öncesi, sonras› 1 ve 3. aylarda de¤erlendirildi. Artrokinematik parametreler olarak boyun postür, normal eklem hareketi, kas kuvvet ve endurans› de¤erlendirildi. Klinik ve radyolojik yutma fonksiyon de¤er-lendirmeleri de yap›ld›. Hastalar›n yafl ortalamas› 53,22±10,92 y›ld›. Postür analizinde bafl anterior tilti, kifoz ve omuz protraksiyonu RT sonras› 3. ayda daha fazla idi (p< 0.001). RT sonras› boyun fleksiyon, lateral fleksiyon ve rotasyon limitasyonlar› artt› (p< 0.001), boyun kas kuvvet ve endurans› giderek azald› (p< 0.001). Ayn› zamanda RT sonras› tüm bu yan etkilerle birlikte yutma fazlar› kötü yönde etkilendi (p< 0.001) ve tüm k›vamlarda aspirasyon fliddeti giderek artt› (p< 0.05). Sonuç olarak RT erken dönemden itibaren olumsuz etkilerini göstermeye bafllamaktad›r. Di¤er çal›flmalardan farkl› olarak RT'nin bafl ve boyun yap›lar›n› olumsuz yönde etkiledi¤i ortaya konuldu ve bu da RT'nin yutma fonksiyonunu nas›l etkiledi¤i aç›klamaktad›r. Bu yüzden yutma rehabilitasyonuna bafl boyun yap› hareketlilik, kuvvet ve endurans de¤erlendirme ve egzersizlerini dahil etmek çok önemlidir.

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Patient-Perceived and Objective Functional Outcomes Following Transoral Robotic Surgery for Early Oropharyngeal Carcinoma

Sinclair¹

2011

Arch Otolaryngol Head Neck Surg

120

141

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Objective The aim of this study was to develop a predictive model of objective oropharyngeal obstructive sleep apnea (OSA) surgery outcomes including success rate and apnea-hypopnea index (AHI) reduction ratio in adult OSA patients. Study design Retrospective outcome research. Methods All subjects with OSA who underwent oropharyngeal and/or nasal surgery and were followed for at least 3 months were enrolled in this study. Demographic, anatomical [tonsil size (TS) and palate-tongue position (PTP) grade (Gr)], and polysomnographic parameters were analyzed. The AHI reduction ratio (%) was defined as [(postoperative AHI-preoperative AHI) x 100 / postoperative AHI], and surgical success was defined as a ! 50% reduction in preoperative AHI with a postoperative AHI < 20.

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Swallowing disorders in the first year after radiation and chemoradiation

Abstract: Background-Radiation alone or concurrent chemoradiation can result in severe swallowing disorders. This manuscript defines the swallowing disorders occurring at pretreatment and 3 and 12 months after completion of radiation or chemoradiation.

Cited by 186 publications

References 12 publications

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

Head and Neck Cancer: Changes in Artrokinematic Parameters of Neck and Swallowing Function after Radiotherapy

Patient-Perceived and Objective Functional Outcomes Following Transoral Robotic Surgery for Early Oropharyngeal Carcinoma

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