Skip to main content
SpringerLink
Log in

Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Patients with advanced laryngeal and hypopharyngeal cancer are often treated with chemo-radiotherapy to avoid total laryngectomy. Subclinical swallowing disorders could be present in these patients even though patients do not complain of any symptoms. We sought to evaluate the impact of chemoradiation on swallowing and quality of life.

Methods

We studied 21 patients undergoing chemo-radiotherapy for advanced laryngeal and hypopharyngeal cancer. All patients were tumor-free and none reported symptoms related to dysphagia during follow-up or showed altered routine screening tests (EAT-10) to detect it. Swallowing functions were assessed using volume–viscosity swallow test (V–VST) and fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life was assessed with the EORT-H&N35, and SWAL-QOL scales.

Results

Frequent alterations in swallowing efficacy (100%) and safety (85.5%) were detected with V–VST and FEES. Quality-of-life scales showed a reduction in their scores between 12 and 17%, mainly in the areas of symptoms.

Conclusion

Swallowing disorders are common after chemo-radiotherapy, even in patients who do not clinically manifest these disorders, contributing to a decrease in patients' quality of life. FEES and V–VST are useful procedures to detect asymptomatic swallowing disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V, EHNS Executive Board; ESMO Guidelines Committee; ESTRO Executive Board (2020) Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 31(11):1462–1475. https://doi.org/10.1016/j.annonc.2020.07.011

    Article  PubMed  Google Scholar 

  2. Pignon JP, le Maître A, Maillard E, Bourhis J, MACH-NC Collaborative Group (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14. https://doi.org/10.1016/j.radonc.2009.04.014

    Article  PubMed  Google Scholar 

  3. Lazarus CL (2009) Effects of chemoradiotherapy on voice and swallowing. Curr Opin Otolaryngol Head Neck Surg 17:172–178. https://doi.org/10.1097/MOO.0b013e32832af12f

    Article  PubMed  PubMed Central  Google Scholar 

  4. Patterson JM (2019) Late effects of organ preservation treatment on swallowing and voice; presentation, assessment, and screening. Front Oncol 9:401. https://doi.org/10.3389/fonc.2019.00401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kraaijenga S, Oskam IM, van der Molen L, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM (2015) Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral Oncol 51:787–794. https://doi.org/10.1016/j.oraloncology.2015.05.003

    Article  CAS  PubMed  Google Scholar 

  6. van der Molen L, Heemsbergen WD, de Jong R, van Rossum MA, Smeele LE, Rasch CR, Hilgers FJ (2013) Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Radiother Oncol 106:364–369. https://doi.org/10.1016/j.radonc.2013.03.005

    Article  PubMed  Google Scholar 

  7. Jacobi I, van der Molen L, Huiskens H, van Rossum MA, Hilgers FJ (2010) Voice and speech outcomes of chemoradiation for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 267:1495–1505. https://doi.org/10.1007/s00405-010-1316-x

    Article  PubMed  PubMed Central  Google Scholar 

  8. Francis DO, Weymuller EA, Parvathaneni U, Merati AL, Yueh B (2010) Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter? Ann Otol Rhinol Laryngol 119:391–397. https://doi.org/10.1177/000348941011900605

    Article  PubMed  Google Scholar 

  9. King SN, Dunlap NE, Tennant PA, Pitts T (2016) Pathophysiology of radiation-induced dysphagia in head and neck cancer. Dysphagia 31:339–351. https://doi.org/10.1007/s00455-016-9710-1

    Article  PubMed  PubMed Central  Google Scholar 

  10. Carmignani I, Locatello LG, Desideri I, Bonomo P, Olmetto E, Livi L, Le Saec O, Coscarelli S, Mannelli G (2018) Analysis of dysphagia in advanced-stage head-and-neck cancer patients: impact on quality of life and development of a preventive swallowing treatment. Eur Arch Otorhinolaryngol 275:2159–2167. https://doi.org/10.1007/s00405-018-5054-9

    Article  PubMed  Google Scholar 

  11. Vainshtein JM, Moon DH, Feng FY, Chepeha DB, Eisbruch A, Stenmark MH (2015) Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer. Int J Radiat Oncol Biol Phys 91:925–933. https://doi.org/10.1016/j.ijrobp.2014.12.045

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wan Leung S, Lee TF, Chien CY, Chao PJ, Tsai WL, Fang FM (2011) Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. BMC Cancer 11:128. https://doi.org/10.1186/1471-2407-11-128

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ham JC, van Herpen CML, Driessen CML, van der Graaf WTA, Husson O (2019) Health-related quality of life of patients treated with chemoradiotherapy plus or minus prophylactic antibiotics to reduce the number of pneumonias for locally advanced head and neck cancer, the PANTAP study. Oral Oncol 96:105–112. https://doi.org/10.1016/j.oraloncology.2019.07.014

    Article  PubMed  Google Scholar 

  14. Rinkel RN, Verdonck-de Leeuw IM, Doornaert P, Buter J, de Bree R, Langendijk JA, Aaronson NK, Leemans CR (2016) Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer based on cut-off scores of the patient-reported outcome measures SWAL-QOL and SHI. Eur Arch Otorhinolaryngol 273:1849–1855. https://doi.org/10.1007/s00405-015-3680-z

    Article  PubMed  Google Scholar 

  15. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ (2008) Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 117:919–924. https://doi.org/10.1177/000348940811701210

    Article  PubMed  Google Scholar 

  16. Urba S, Wolf G, Eisbruch A, Worden F, Lee J, Bradford C, Teknos T, Chepeha D, Prince M, Hogikyan N, Taylor J (2006) Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol 24:593–598. https://doi.org/10.1200/JCO.2005.01.2047

    Article  CAS  PubMed  Google Scholar 

  17. Rofes L, Arreola V, Clavé P (2012) The volume-viscosity swallow test for clinical screening of dysphagia and aspiration. Nestle Nutr Inst Workshop Ser 72:33–42. https://doi.org/10.1159/000339979

    Article  PubMed  Google Scholar 

  18. Guillen-Sola A, Soler NB, Marco E, Pera-Cegarra O, Foro P (2019) Effects of prophylactic swallowing exercises on dysphagia and quality of life in patients with head and neck cancer receiving (chemo) radiotherapy: the Redyor study, a protocol for a randomized clinical trial. Trials 20:503. https://doi.org/10.1186/s13063-019-3587-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Langmore SE (2017) History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years. Dysphagia 32:27–38. https://doi.org/10.1007/s00455-016-9775-x

    Article  PubMed  Google Scholar 

  20. Deutschmann MW, McDonough A, Dort JC, Dort E, Nakoneshny S, Matthews TW (2013) Fiber-optic endoscopic evaluation of swallowing (FEES): predictor of swallowing-related complications in the head and neck cancer population. Head Neck 35:974–979. https://doi.org/10.1002/hed.23066

    Article  PubMed  Google Scholar 

  21. Mamolar Andrés S, Santamarina Rabanal ML, Granda Membiela CM, Fernández Gutiérrez MJ, Sirgo Rodríguez P, Álvarez MC (2017) Swallowing disorders in Parkinson’s disease. Acta Otorrinolaringol Esp 68:15–22. https://doi.org/10.1016/j.otorri.2016.02.001

    Article  PubMed  Google Scholar 

  22. Casanueva R, López F, Costales M, Ordas A, Villanueva E, Llorente JL, Alvarez Marcos C (2021) The presence of dysphagia in patients with cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): a subjective and objective study. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-020-06534-2 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  23. Ringash J, Waldron JN, Siu LL, Martino R, Winquist E, Wright JR, Nabid A, Hay JH, Hammond A, Sultanem K, Hotte S, Leong C, El-Gayed AA, Naz F, Ramchandar K, Owen TE, Montenegro A, O’Sullivan B, Chen BE, Parulekar WR (2017) Quality of life and swallowing with standard chemoradiotherapy versus accelerated radiotherapy and panitumumab in locoregionally advanced carcinoma of the head and neck: a phase III randomised trial from the Canadian Cancer Trials Group (HN.6). Eur J Cancer 72:192–199. https://doi.org/10.1016/j.ejca.2016.11.008

    Article  CAS  PubMed  Google Scholar 

  24. Florie M, Pilz W, Kremer B, Verhees F, Waltman G, Winkens B, Winter N, Baijens L (2021) EAT-10 Scores and fiberoptic endoscopic evaluation of swallowing in head and neck cancer patients. Laryngoscope 131:E45–E51. https://doi.org/10.1002/lary.28626

    Article  PubMed  Google Scholar 

  25. Arrese LC, Carrau R, Plowman EK (2017) Relationship between the Eating Assessment Tool-10 and objective clinical ratings of swallowing function in individuals with head and neck cancer. Dysphagia 32:83–89. https://doi.org/10.1007/s00455-016-9741-7

    Article  PubMed  Google Scholar 

  26. Denaro N, Merlano MC, Russi EG (2013) Dysphagia in head and neck cancer patients: pretreatment evaluation, predictive factors, and assessment during radio-chemotherapy, recommendations. Clin Exp Otorhinolaryngol 6:117–126. https://doi.org/10.3342/ceo.2013.6.3.117

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gaziano JE (2002) Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control 9:400–409. https://doi.org/10.1177/107327480200900505

    Article  PubMed  Google Scholar 

  28. Pauloski BR (2008) Rehabilitation of dysphagia following head and neck cancer. Phys Med Rehabil Clin N Am 19:889–928. https://doi.org/10.1016/j.pmr.2008.05.010

    Article  PubMed  PubMed Central  Google Scholar 

  29. Platteaux N, Dirix P, Dejaeger E, Nuyts S (2010) Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia 25:139–152. https://doi.org/10.1007/s00455-009-9247-7

    Article  PubMed  Google Scholar 

  30. Messing BP, Ward EC, Lazarus CL, Kim M, Zhou X, Silinonte J, Gold D, Harrer K, Ulmer K, Merritt S, Neuner G, Levine M, Blanco R, Saunders J, Califano J (2017) Prophylactic swallow therapy for patients with head and neck cancer undergoing chemoradiotherapy: a randomized trial. Dysphagia 32:487–500. https://doi.org/10.1007/s00455-017-9790-6

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kraaijenga SAC, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM (2015) Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol 272:3521–3531. https://doi.org/10.1007/s00405-014-3379-6

    Article  PubMed  Google Scholar 

  32. Govender R, Smith CH, Gardner B, Barratt H, Taylor SA (2017) Improving swallowing outcomes in patients with head and neck cancer using a theory-based pretreatment swallowing intervention package: protocol for a randomised feasibility study. BMJ Open 7:e014167. https://doi.org/10.1136/bmjopen-2016-014167

    Article  PubMed  PubMed Central  Google Scholar 

  33. Arias AF, Arraras JI, Asin G, Uzcanga MI, Maraví E, Chicata V, Eito C, Zarandona U, Mora I, Vila M, Domínguez MA (2015) Quality of life and voice assessment in patients with early-stage glottic cancer. Head Neck 37:340–346. https://doi.org/10.1002/hed.23603

    Article  PubMed  Google Scholar 

  34. Govender R, Smith CH, Taylor SA, Barratt H, Gardner B (2017) Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer 17:43. https://doi.org/10.1186/s12885-016-2990-x

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kim J, Shin ES, Kim JE, Yoon SP, Kim YS (2015) Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer. Radiat Oncol 33:344–349. https://doi.org/10.3857/roj.2015.33.4.344

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from CIBERONC (CB16/12/00390 to JPR), Ayudas a Grupos PCTI Principado de Asturias (IDI2018/155 to JPR), Fundación Bancaria Caja de Ahorros de Asturias-IUOPA and the FEDER Funding Program from the European Union.

Funding

This study was supported by grants from CIBERONC (CB16/12/00390 to JPR), Ayudas a Grupos PCTI Principado de Asturias (IDI2018/155 to JPR), Fundación Bancaria Caja de Ahorros de Asturias-IUOPA and the FEDER Funding Program from the European Union.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Hospital Universitario Central de Asturias (HUCA), Avenida de Roma, s/n, 33011, Oviedo, Spain

    César Álvarez-Marcos, Daniel Pedregal-Mallo, José Luis Llorente, Fernando López & Juan Pablo Rodrigo

  2. Department of Head and Neck Cancer, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

    César Álvarez-Marcos, Daniel Pedregal-Mallo, José Luis Llorente, Fernando López & Juan Pablo Rodrigo

  3. Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, Oviedo, Spain

    César Álvarez-Marcos, Daniel Pedregal-Mallo, José Luis Llorente, Fernando López & Juan Pablo Rodrigo

  4. CIBERONC, Instituto de Salud Carlos III, Madrid, Spain

    César Álvarez-Marcos, José Luis Llorente, Fernando López & Juan Pablo Rodrigo

  5. Speech Therapy, Faculty of Psychology, University of Oviedo, Oviedo, Spain

    Andrea Vicente Benito, Agueda Gayol Fernández, Paloma Sirgo Rodríguez & Liliana Santamarina Rabanal

Authors
  1. César Álvarez-Marcos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Vicente Benito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Agueda Gayol Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Pedregal-Mallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paloma Sirgo Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liliana Santamarina Rabanal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José Luis Llorente
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fernando López
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juan Pablo Rodrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each of the authors has contributed to, read, and approved this manuscript.

Corresponding author

Correspondence to Fernando López.

Ethics declarations

Conflicts of interest/Competing interests

The authors have no conflicts of interest to disclose.

Ethics approval

All procedures were conducted in accordance to the Declaration of Helsinki and approved by Institutional Ethics Committee of the HUCA (285/18).

Consent to participate

Written informed consent was obtained from each patient.

Consent for publication

This manuscript, or any part of it, has not been previously published; nor is it under consideration for publication elsewhere. I would be most appreciative if you would consider this paper for publication in EAOHNS.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Álvarez-Marcos, C., Benito, A.V., Fernández, A.G. et al. Asymptomatic swallowing disorders may be present in individuals with laryngeal and hypopharyngeal cancer treated with chemo-radiotherapy. Eur Arch Otorhinolaryngol 279, 995–1001 (2022). https://doi.org/10.1007/s00405-021-06861-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-06861-y

Keywords

Search

Navigation