Strahlentherapie und Onkologie

, Volume 189, Issue 3, pp 230–237 | Cite as

Dysphagia after definitive radiotherapy for head and neck cancer

Correlation of dose–volume parameters of the pharyngeal constrictor muscles
  • L. Deantonio
  • L. Masini
  • M. Brambilla
  • F. Pia
  • M. KrengliEmail author
Original article



Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.


A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.


Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥ 50 Gy dose to the whole constrictor muscles ≥ 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.


The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.


Head and neck neoplasms Dysphagia Radiotherapy Pharyngeal constrictor muscles Late toxicity 

Dysphagie nach Strahlentherapie bei Kopf-Hals-Tumoren

Korrelation von Dosis-Volumen-Parametern der Schlundschnürer



Dysphagie ist eine Komplikation, die mit Strahlentherapie (RT) behandelte Kopf-Hals-Tumor-Patienten betrifft. Es wurden die Frequenz und das Ausmaß der Schluckbeschwerden analysiert und die Ergebnisse mit den Dosis-Volumen-Histogrammen (DVHs) der Schlundschnürer korreliert.

Material und Methode

In die Studie wurden 50 Patienten aufgenommen, die mit radikaler RT behandelt wurden. Die DVHs der Schlundschnürer wurden mit der Dysphagie als Akut- bzw. Spätnebenwirkung und mit den Informationen aus drei Fragebögen zur Lebensqualität korreliert.


Bei der univariaten Analyse wiesen die von dem oberen und mittleren Schlundschnürer (M. constrictor pharingis superior und M. constrictor pharingis medius) erhaltene mittlere Bestrahlungsdosis, der Volumenanteil dieser beiden Schlundschnürer mit einer Bestrahlungsdosis ≥ 50 Gy, die Bestrahlungsdosis ≥ 60 Gy an den Schlundschnürern insgesamt und die Tumorlage eine Beziehung zum Auftreten einer Dysphagie als Spätnebenwirkung auf. Bei der multivariaten Analyse war die von dem mittleren Schlundschnürer erhaltene mittlere Bestrahlungsdosis der einzige statistisch signifikante prädiktive Faktor für eine Dysphagie als Spätnebenwirkung.


Die Studie zeigte eine signifikante Beziehung zwischen Langzeitdysphagie und den mittleren Bestrahlungsdosen des oberen und mittleren Schlundschnürers sowie der Schlundschnürer insgesamt. Diese Ergebnisse legen den potenziellen Vorteil einer reduzierten Bestrahlungsdosis an den am Schluckvorgang beteiligten Strukturen zur Vermeidung einer schweren Dysphagie nahe.


Kopf-Hals-Tumor Dysphagie Strahlentherapie Schlundschnürer Spättoxizität 



The authors thank Ms. Nicoletta Negri for the support in the preparation of the manuscript.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Bhide SA, Gulliford S, Kazi R et al (2009) Correlation between dose to the pharyngeal constrictors and patient quality of life and late dysphagia following chemo-IMRT for head and neck cancer. Radiother Oncol 93:539–544PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous (2009) Cancer therapy evaluation program. common terminology criteria for adverse events, version 4.02, DCTD, NCI, DHHSGoogle Scholar
  3. 3.
    Caudell JJ, Schaner PE, Meredith RF et al (2009) Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 73:410–415PubMedCrossRefGoogle Scholar
  4. 4.
    Chen AY, Frankowsky R, Bishop-Leone J et al (2001) The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 127:870–876PubMedCrossRefGoogle Scholar
  5. 5.
    Christianen ME, Langendijk JA, Westerlaan HE et al (2011) Delineation of organs at risk involved in swallowing for radiotherapy treatment. Radiother Oncol 101:394–402PubMedCrossRefGoogle Scholar
  6. 6.
    Christianen MEMC, Schilstra C, Beetz I et al (2012) Predictive modelling for swallowing dysfunction after primary (chemo)radiation: Results of a prospective observational study. Radiother Oncol 105:107–114PubMedCrossRefGoogle Scholar
  7. 7.
    Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346PubMedCrossRefGoogle Scholar
  8. 8.
    Dirix P, Abbeel S, Vanstraelen B et al (2009) Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for swallowing structures. Int J Radiat Oncol Biol Phys 75:385–392PubMedCrossRefGoogle Scholar
  9. 9.
    Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  10. 10.
    Eisbruch A, Kim HM, Feng FY et al (2011) Chemo-IMRT of oropharyngeal cancer aiming to reduce dysphagia: swallowing organs late complication probabilities and dosimetric correlates. Int J Radiat Oncol Biol Phys 81:93–99CrossRefGoogle Scholar
  11. 11.
    Eisbruch A, Liden T, Bradford C et al (2004) Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys 60:1425–1439PubMedCrossRefGoogle Scholar
  12. 12.
    Eisbruch A, Lyden T, Bradford CR et al (2002) Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 53:23–28PubMedCrossRefGoogle Scholar
  13. 13.
    Feng FY, Kim HM, Lyden TH et al (2010) Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol 28:2732–2738PubMedCrossRefGoogle Scholar
  14. 14.
    Feng FY, Kim HM, Lyden TH et al (2007) Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 68:1289–1298PubMedCrossRefGoogle Scholar
  15. 15.
    Franzmann EJ, Lundy DS, Abitbol AA, Goodwin WJ (2006) Complete hypopharyngeal obstruction by mucosal adhesions: a complication of intensive chemoradiation for advanced head and neck cancer. Head Neck 28:663–670PubMedCrossRefGoogle Scholar
  16. 16.
    Gregoire V, Eisbruch A, Hamoir M, Levendag P (2006) Proposal for delineation of the nodal CTV in the node-positive and in post-operative neck. Radiother Oncol 79:15–20PubMedCrossRefGoogle Scholar
  17. 17.
    Gregoire V, Levendag P, Ang KK et al (2003) CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol 69:227–236PubMedCrossRefGoogle Scholar
  18. 18.
    Jensen K, Lambertsen K, Grau C (2007) Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol 85:74–82PubMedCrossRefGoogle Scholar
  19. 19.
    Levendag PC, Teguh DN, Voet P et al (2007) Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol 85:64–73PubMedCrossRefGoogle Scholar
  20. 20.
    List MA, D’Antonio LL, Cella DF et al (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale. A study of utility and validity. Cancer 77:2294–2301PubMedCrossRefGoogle Scholar
  21. 21.
    Maurer J, Hipp M, Schafer C et al (2011) Dyphagia. Impact on quality of life after radio(chemotherapy) of head and neck cancer. Strahlenther Onkol 187:744–749PubMedCrossRefGoogle Scholar
  22. 22.
    Nguyen NP, Frank C, Moltz CC et al (2006) Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol 80:302–306PubMedCrossRefGoogle Scholar
  23. 23.
    Nguyen NP, Frank C, Moltz et al (2005) Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys 61:772–778PubMedCrossRefGoogle Scholar
  24. 24.
    Pauloski B, Rademaker A, Logemann J et al (2006) Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck 28:1069–1076PubMedCrossRefGoogle Scholar
  25. 25.
    Peponi E, Glanzmann C, Willi B et al (2011) Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT). Radiat Oncol 6:1–8PubMedCrossRefGoogle Scholar
  26. 26.
    Pignon JP, Bourhis J, Domenge C, Designè L (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355:949–955PubMedGoogle Scholar
  27. 27.
    Pignon JP, le Maitre A, Maillard E, Bourhis J (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14PubMedCrossRefGoogle Scholar
  28. 28.
    Platteaux N, Dirix P, Dejaeger E, Nuyts S (2010) Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia 25:139–152PubMedCrossRefGoogle Scholar
  29. 29.
    Rancati T, Schwarz M, Allen AM et al (2010) Radiation dose-volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys 76:64–69CrossRefGoogle Scholar
  30. 30.
    Sherman AC, Simonton S, Camps Adams D et al (2000) Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H&N35). Arch Otolaryngol Head Neck Surg 126:459–467PubMedGoogle Scholar
  31. 31.
    Tang Y, Shen Q, Wang Y et al (2011) A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol 187:39–44PubMedCrossRefGoogle Scholar
  32. 32.
    Truong MT, Lee R, Saito N et al (2012) Correlating computed tomography perfusion changes in the pharyngeal constrictor muscles during head-and-neck radiotherapy to dysphagia outcome. Int J Radiat Oncol Biol Phys 82:119–127CrossRefGoogle Scholar

Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  • L. Deantonio
    • 1
  • L. Masini
    • 1
  • M. Brambilla
    • 2
  • F. Pia
    • 3
    • 4
  • M. Krengli
    • 1
    • 5
    Email author
  1. 1.RadiotherapyUniversity Hospital “Maggiore della Carità”NovaraItaly
  2. 2.Medical PhysicsUniversity Hospital “Maggiore della Carità”NovaraItaly
  3. 3.OtolaryngologyUniversity Hospital “Maggiore della Carità”NovaraItaly
  4. 4.Department of Medical SciencesUniversity of “Piemonte Orientale”NovaraItaly
  5. 5.Department of Translational Medicine and BRMAUniversity of “Piemonte Orientale”NovaraItaly

Personalised recommendations