Dysphagia

, Volume 26, Issue 4, pp 399–406 | Cite as

Objective Assessment of Swallowing Function After Definitive Concurrent (Chemo)radiotherapy in Patients with Head and Neck Cancer

  • Jaiprakash Agarwal
  • Vijay Palwe
  • Debnarayan Dutta
  • Tejpal Gupta
  • Sarbani Ghosh Laskar
  • Ashwini Budrukkar
  • Vedang Murthy
  • Pankaj Chaturvedi
  • Prathamesh Pai
  • Devendra Chaukar
  • Anil K. D’Cruz
  • Suyash Kulkarni
  • Aniruddha Kulkarni
  • Gurmit Baccher
  • Shyam Kishore Shrivastava
Original Article
First Online:
Received:
Accepted:

Abstract

The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1–4, N0–3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration–aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration–aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n = 34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P = 0.05), and large tumor volume (P = 0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.

Keywords

Chemoradiotherapy Modified barium swallow Penetration–aspiration scale Swallowing function Deglutition Deglutition disorders 
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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jaiprakash Agarwal
    • 1
  • Vijay Palwe
    • 1
  • Debnarayan Dutta
    • 1
  • Tejpal Gupta
    • 1
  • Sarbani Ghosh Laskar
    • 1
  • Ashwini Budrukkar
    • 1
  • Vedang Murthy
    • 1
  • Pankaj Chaturvedi
    • 2
  • Prathamesh Pai
    • 2
  • Devendra Chaukar
    • 2
  • Anil K. D’Cruz
    • 2
  • Suyash Kulkarni
    • 3
  • Aniruddha Kulkarni
    • 3
  • Gurmit Baccher
    • 4
  • Shyam Kishore Shrivastava
    • 1
  1. 1.Department of Radiation OncologyTata Memorial HospitalMumbaiIndia
  2. 2.Department of Surgical OncologyTata Memorial HospitalMumbaiIndia
  3. 3.Department of Interventional RadiologyTata Memorial HospitalMumbaiIndia
  4. 4.Department of Speech TherapyTata Memorial HospitalMumbaiIndia

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