Strahlentherapie und Onkologie

, Volume 194, Issue 12, pp 1114–1123 | Cite as

Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study

  • Stefano UrsinoEmail author
  • Paola Cocuzza
  • Veronica Seccia
  • Durim Delishaj
  • Agostino Cristaudo
  • Francesco Pasqualetti
  • Patrizia Giusti
  • Stefania Santopadre
  • Riccardo Morganti
  • Francesco Fiorica
  • Fabiola Paiar
  • Bruno Fattori
Original Article


Background and purpose

A prospective instrumental assessment of late dysphagia using swallowing organs at risk (SWOARs)-sparing IMRT for nasopharyngeal and oropharyngeal cancers.

Materials and methods

Objective instrumental assessment included fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFS) at baseline, and at 6 and 12 months after treatment. FEES assessed the pharyngeal residue according to the Farneti pooling score (P-score) as follows: 4–5 no dysphagia; 6–7 mild dysphagia; 8–9 moderate dysphagia; 10–11 severe dysphagia. Three different consistencies were tested for the P‑score: liquid (L), semisolid (SS), and solid (S). VFS assessed penetration-aspiration according to the Penetration-Aspiration Scale (PAS) and two different consistencies of the bolus were tested: thin liquid barium (L) and paste barium (S).


38 patients were evaluable. There was a significant worsening of the P‑score at 6 months both for SS (p = 0.015) and S (p < 0.001), which persisted only for S at 12 months (p < 0.0001). Similarly, there was a significant worsening of the PAS score at 6 and 12 months (p = 0.065 and 0.039, respectively) for the S bolus. Overall, 3–7 and 10–14% aspiration after L and S was observed, respectively.


Promising results using a SWOARs-sparing IMRT technique are reported. Therefore, treatment plans should be optimized for reducing doses to these structures.


Radiotherapy Dysphagia Aspiration-pneumonia Fiberoptic endoscopic evaluation of swallowing Videofluoroscopy 

Muster von Dysphagie nach intensitätsmodulierter Strahlentherapie unter Schonung schluckrelevanter Strukturen bei Kopf-Hals-Tumoren: Ergebnisse einer monoinstitutionellen prospektiven Studie


Hintergrund und Zielsetzung

Eine prospektive instrumentelle Einschätzung der späten Dysphagie bei intensitätsmodulierter Strahlentherapie (IMRT) unter Schonung schluckrelevanter Strukturen (SWOAR, „swallowing organs at risk“) bei Nasopharynx- und Oropharynxkarzinomen.

Material und Methoden

Die objektive instrumentelle Einschätzung beinhaltete die glasfaseroptisch-endoskopische-Einschätzung des Schluckakts (FEES, „fiberoptic endoscopic evaluation of swallowing“) sowie eine Videofluoroskopie (VFS) zu Beginn sowie nach 6 und 12 Monaten nach der Behandlung. FEES bewertete den pharyngealen Restrückstand nach dem Farneti-Pooling-Score (P-Score) wie folgt: 4–5 keine Dysphagie; 6–7 leichte Dysphagie; 8–9 moderate Dysphagie; 10–11 schwere Dysphagie. Drei verschiedene Konsistenzen wurden für den P‑Score getestet: flüssig (L), halbflüssig (SS) und fest (S). Die VFS bewertete Penetration und Aspiration anhand der Penetration-Aspiration-Skala (PAS). Es wurden 2 verschiedene Boluskonsistenzen geprüft: dünnflüssiger Bariumbrei (L) und dickflüssiger Bariumbrei (S).


Es konnten 38 Patienten evaluiert werden. Eine signifikante Verschlechterung des P‑Scores zeigte sich nach 6 Monaten sowohl für SS (p = 0,015) als auch für S (p < 0,001), der allerdings nur bei S auch nach 12 Monaten weiter bestand (p < 0,0001). Gleichermaßen ergab sich für den S‑Bolus eine signifikante Verschlechterung des PAS-Werts nach 6 und 12 Monaten (jeweils p = 0,065 bzw. p = 0,039). Insgesamt wurde nach L und S eine Aspiration von jeweils 3–7 % und 10–14 % beobachtet.


Die Ergebnisse bei Verwendung einer SWOAR-schonenden IMRT-Technik sind vielversprechend. Daher sollten die Behandlungspläne optimiert werden, um die Dosis für diese Strukturen zu verringern.


Strahlentherapie Dysphagie Aspirationspneumonie Fiberoptische endoskopische Beurteilung des Schluckens Videofluoroskopie 


Compliance with ethical guidelines

Conflict of interest

Travel, congress, and course grants (Merck Serono, Nestlè, Kyowakirin) have to be declared for authors S. Ursino, S. Santopadre, V. Seccia, and B. Fattori. Travel, congress, and course grants (Merck Serono, Nestlè, Kyowakirin, Varian) have to be declared for author F. Paiar. P. Cocuzza, Durim Delishaj, A. Cristaudo, F. Pasqualetti, P. Giusti, R. Morganti, and F. Fiorica declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Supplementary material

66_2018_1328_MOESM1_ESM.doc (72 kb)
Target volume delineation criteria and dose fractionation schedule; Dosimetric Treatment Plan Evaluation Criteria; Constraints of primary and secondary organs at risk including optimization criteria for Swallowing Organs at risk


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stefano Ursino
    • 1
    • 7
    Email author
  • Paola Cocuzza
    • 1
  • Veronica Seccia
    • 2
  • Durim Delishaj
    • 1
  • Agostino Cristaudo
    • 1
  • Francesco Pasqualetti
    • 1
  • Patrizia Giusti
    • 3
  • Stefania Santopadre
    • 4
  • Riccardo Morganti
    • 5
  • Francesco Fiorica
    • 6
  • Fabiola Paiar
    • 1
  • Bruno Fattori
    • 4
  1. 1.Department of Radiation OncologyUniversity Hospital S. ChiaraPisaItaly
  2. 2.First Otorhinolaryngology UnitUniversity Hospital CisanelloPisaItaly
  3. 3.Department of RadiologyUniversity Hospital CisanelloPisaItaly
  4. 4.Otorhinolaryngology-Audiology-Phoniatric UnitUniversity Hospital CisanelloPisaItaly
  5. 5.Department of Clinical and Experimental MedicineSection of StatisticsPisaItaly
  6. 6.Department of Radiation OncologyUniversity Hospital FerraraCona, FerraraItaly
  7. 7.Department of Radiation OncologyUniversity Hospital Santa ChiaraPisaItaly

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