Swallowing outcomes in patients with oropharyngeal cancer undergoing organ‐ preservation treatment

Abstract

This study demonstrates that patients undergoing nonsurgical treatment for oropharyngeal SCC are at risk for posttreatment dysphagia. This suggests a need for dysphagia evaluation/management and refinement of interventions to minimize dysphagia.

Long-Term, Prospective Performance of the MD Anderson Dysphagia Inventory in “Low-Intermediate Risk” Oropharyngeal Carcinoma After Intensity Modulated Radiation Therapy

“…Larger sample sizes are needed to power hypotheses regarding differences between staging subgroups. Evidence of associations between age, T stage, and site of disease with long-term swallowing outcomes in OPC cohorts is reported by many investigators and supports need for prospective identification of patients at higher risk for poorer swallowing outcomes [31–33]. …”

The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

“…This is an 8-point ordinal ranking scale that evaluates as follows: normal swallowing (scores 1-2), and abnormal swallows where ingested material enters the larynx at or above the vocal folds and is ejected (scores 3-4) or is not ejected (score 5). As well, the PAS considers more severe dysphagia as abnormal swallows that involve aspiration where ingested material passes the vocal folds and is ejected (score 6), is not ejected despite effort (score 7), or no effort is made to eject the aspirated material (8). Thus, scores of one or two were considered normal and scores of three or greater were considered to be abnormal [19].…”

“…Acute toxicities may influence long-term patient outcomes [4]. Multiple physiologic deficits have been associated with RT/CRT including poor laryngeal elevation, decreased pharyngeal constriction, lack of epiglottic tilt, poor airway protection, and reduced tongue base retraction [5][6][7][8]. However, data regarding swallowing temporal kinematics of patients following head and neck cancer treatment is lacking.…”

Dysphagia in head and neck cancer

“…With a rising epidemic of HNCA associated with human papilloma virus (HPV) and the favorable oncologic outcomes associated with this disease [35,36], de-intensification treatment efforts have appeared more feasible. Treatment de-intensification is particularly attractive given that despite better oncologic outcomes, patients with HPVassociated HNCA do not appear to have reduced risk of developing dysphagia [4]. Three treatment approaches are currently under investigation and show promise for reducing long-term swallowing toxicities.…”

“…However, organ preservation does not necessarily equate to preservation of function. A substantial body of evidence suggests that patients receiving nonsurgical treatment for HNCA are at risk for both acute toxicities and long-term alteration of swallow function [1][2][3][4]. Such alterations may contribute to long-term decrements in health status and quality of life [5][6][7][8].…”