The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy

Evangelista, Lisa; Bayoumi, Ahmed M.; Dyer, Brandon A.; Shukla, Rakendu; Rao, Shyam; Belafsky, Peter C.

doi:10.1080/00016489.2020.1752933

Cited by 4 publications

(7 citation statements)

References 8 publications

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“…HL and PPWhold correlated with PAS, and PCR correlated with FOIS outcomes similar to other studies. 51,[59][60][61] These findings support the utilization of PPWhold and HL to predict future aspiration risk and to establish targeted swallow therapy to improve hyolaryngeal mobility. Along with Stokely et al, who demonstrated poor PCR correlates increased post-swallow residues, 62 this study supports using interventions that target improvement in PCR to potentially improve patient dietary outcome.…”

Section: Discussionsupporting

confidence: 53%

“…PPWhold is a measure of interest because increased thickness may result in reduced pharyngeal contractility, impaired bolus clearance, and increased pharyngeal residue. 42,51 In fact, Evangelista et al reported posterior pharyngeal wall thickening 3 months after radiation to be an independent risk factor for increased pharyngeal residue, post-deglutitive aspiration, and worse PAS scores. 51 Similarly, both PAS and FOIS worsened in this study cohort as PPWhold increased.…”

Section: Discussionmentioning

confidence: 99%

“…42,51 In fact, Evangelista et al reported posterior pharyngeal wall thickening 3 months after radiation to be an independent risk factor for increased pharyngeal residue, post-deglutitive aspiration, and worse PAS scores. 51 Similarly, both PAS and FOIS worsened in this study cohort as PPWhold increased. After peaking, posterior pharyngeal wall thickness decreased between 6 and 12 months, likely as a result of recovery from treatment-related mucositis and decreased pharyngeal edema.…”

Section: Discussionmentioning

confidence: 99%

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Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment

et al. 2022

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Background/Objective Quantitative swallowing displacement kinematics evolve in patients treated for oropharyngeal squamous cell carcinoma (OPSCC). We aimed to longitudinally assess these measurements and correlate them with functional swallowing outcomes. Method A retrospective review was conducted on patients with OPSCC treated with definitive (chemo)radiation ([C]RT) or surgery with adjuvant (chemo)radiation (S‐[C]RT) who completed at least two videofluoroscopic swallow studies (VFSS). Longitudinal analysis was accomplished via mixed‐effects logistic regression for the Functional Oral Intake Scale (FOIS), and Penetration Aspiration Scale (PAS), and mixed‐effects linear regression for kinematic measures. Spearman's correlation was conducted between changes in FOIS/PAS and kinematic measures. Results Ninety‐seven patients (76 males; mean age 61) completed 245 VFSS studies. A total of 94% had human papillomavirus (HPV)/p16 positive OPSCC and 74% were T0–T2. Sixty‐four patients underwent [C]RT while 33 patients underwent S‐[C]RT. After treatment, posterior pharyngeal wall at hold (PPWhold) increased 3.2 standard deviation (SD) between 0 and 6 months (p < 0.001), then decreased 2.2 SD between 6 and 12 months (p < 0.001) and did not return to baseline. Hyoid‐to‐larynx (HL) (p = 0.046) and maximal hyoid displacement (Hmax) + HL (p = 0.042) increased between 6 and 12 months. Hmax (p = 0.020) and Hmax + HL (p < 0.001) decreased between 12–24 months beyond baseline values. The decrease in HL and increase in PPWhold (p < 0.05) correlated with an increase in PAS. From baseline, increased pharyngeal constriction ratio correlated with decreased FOIS and PPWhold (p < 0.05). Conclusions Quantitative swallowing kinematic measures can effectively track changes in swallowing physiology. Increased PPWhold and restricted hyolaryngeal movement were seen in patients with OPSCC after treatment and correlated with a change in swallowing outcome, emphasizing the need for serial VFSS monitoring and targeted intervention. Level of Evidence 3 Laryngoscope, 133:1339–1348, 2023

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment

et al. 2022

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“…Radical resection of the PPW, which left only a narrow strip of PPW mucosa, seemed to be questionable to prevent or ameliorate postoperative dysphagia and swallowing. In the pharyngeal stage of swallowing, pharyngeal shortening and PPW elevation have an important role in making pharyngeal propulsive forces that enable the swallowing of foods ( 19 – 21 ). Functional impairment of PPW induces pharyngeal dilation and reduces pharyngeal contractions.…”

Section: Discussionmentioning

confidence: 99%

“…This was considered due to the circumferential tumor invading-fields of the PPW being wider than the other subsites. Evangelista et al reported that the PPW thickness increased significantly after radiation therapy in HNC and that increased PPW thickness was an independent risk factor for increased pharyngeal residue, worse penetration-aspiration scores, and increased post-deglutitive aspiration ( 19 ). Based on these reports, PPW impairment induced by radical surgical resection also seems strongly associated with postoperative dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer

et al. 2022

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ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p < 0.001). Patients who underwent total laryngectomy with total/partial pharyngectomy were more likely to have dysphagia than those in the larynx-preserving pharyngectomy groups (odds ratio [OR] = 3.208, 95% confidence interval [CI] 1.283–8.024, p = 0.011). Concerning the posterior pharyngeal wall (PPW), which has an important role in swallowing, patients who underwent resection of ≥1/2 of the PPW were more likely to have dysphagia (OR = 7.467, 95% CI 1.799–30.994, p = 0.003).ConclusionsSurgical resection extent was proportionally associated with dysphagia in hypopharyngeal cancer patients. Patients with smaller lesions but no laryngeal invasion had better postoperative swallowing function than patients with larger lesions or laryngeal involved lesions. Preserving the larynx and hypopharyngeal mucosa (especially the PPW) as much as possible can help preserve postoperative swallowing function.

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Initial Proof‐of‐Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool

Gregor,

Chang,

Keole

et al. 2024

Head & Neck

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BackgroundExternal and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed.MethodsFluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t‐test was used to assess changes in pre and post measures. A post‐treatment survey was completed.ResultsAll 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit.ConclusionsA single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post‐radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL.

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The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy

Cited by 4 publications

References 8 publications

Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment

Longitudinal Analysis of Swallowing Displacement Kinematics After Oropharyngeal Cancer Treatment

Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer

Initial Proof‐of‐Concept Study on Immediate Effects of External Advanced Pneumatic Compression on Pharyngeal and Laryngeal Internal Lymphedema Using a Fluoroscopic Measurement Tool

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