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Dysphagia

, Volume 29, Issue 6, pp 663–670 | Cite as

Functional Swallowing Outcomes in Nasopharyngeal Cancer Treated with IMRT at 6 to 42 months Post-Radiotherapy

  • Margaret Patterson
  • Rowena Brain
  • Ronald Chin
  • David Veivers
  • Michael Back
  • Andrew Wignall
  • Thomas Eade
Original Article

Abstract

We sought to evaluate the swallowing function of 18 patients surviving nasopharyngeal cancer, who had been treated using an intensity-modulated radiotherapy (IMRT) protocol designed to minimise functional impairment. We compared the outcomes of a patient-reported oral function score with fiberoptic endoscopic examination of swallow (FEES), Australian Therapy Outcome Measures (AusTOMs) and a measure of trismus. While all patients returned to a fully oral diet, there was ongoing swallow dysfunction characterised by bolus residue and delay, but no aspiration. Dysphagia was of mild or moderate severity on all measures, generally because of the need for texture modification, impaired bolus transit or dysgeusia. There was xerostomia on self-reported measurement combined with reports of behaviours adaptive to xerostomia on AusTOMs; however, salivary functioning was less impaired on FEES. There was no trismus in this cohort. Our cohort lacked the morbidity experienced by cohorts reported in earlier studies, potentially due to the use of IMRT.

Keywords

Deglutition and deglutition disorders Swallowing Nasopharyngeal cancer IMRT Xerostomia 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Chen QY, Wen YF, Guo L, Liu H, Huang PY, Mo HY, Li NW, Xiang YQ, Luo DH, Qiu F, Sun R, Deng MQ, Chen MY, Hua YJ, Guo X, Cao KJ, Hong MH, Qian CN, Mai HQ. Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst. 2011;103(23):1761–70. doi: 10.1093/jnci/djr432.PubMedCrossRefGoogle Scholar
  2. 2.
    Lovell SJ, Wong HB, Loh KS, Ngo RY, Wilson JA. Impact of dysphagia on quality-of-life in nasopharyngeal carcinoma. Head Neck. 2005;27(10):864–72. doi: 10.1002/hed.20250.PubMedCrossRefGoogle Scholar
  3. 3.
    Lazarus CL. Effects of chemoradiotherapy on voice and swallowing. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):172–8. doi: 10.1097/MOO.0b013e32832af12f.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Lazarus CL, Logemann JA, Pauloski BR, Colangelo LA, Kahrilas PJ, Mittal BB, Pierce M. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996;106(9 Pt 1):1157–66.PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper JS, Fu K, Marks J, Silverman S. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys. 1995;31(5):1141–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Nageris B, Lavelle W, Elidan J. Multiple late complications of irradiation treatment of nasopharyngeal carcinoma. Ear Nose Throat J. 1995;74(4):286–8.PubMedGoogle Scholar
  7. 7.
    Mahdavi R, Faramarzi E, Mohammad-Zadeh M, Ghaeammaghami J, Jabbari MV. Consequences of radiotherapy on nutritional status, dietary intake, serum zinc and copper levels in patients with gastrointestinal tract and head and neck cancer. Saudi Med J. 2007;28(3):435–40.PubMedGoogle Scholar
  8. 8.
    Hughes PJ, Scott PM, Kew J, Cheung DM, Leung SF, Ahuja AT, van Hasselt CA. Dysphagia in treated nasopharyngeal cancer. Head Neck. 2000;22(4):393–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia. 2003;18(2):135–43.PubMedCrossRefGoogle Scholar
  10. 10.
    Platteaux N, Dirix P, Vanstraelen B, Nuyts S. Outcome after re-irradiation of head and neck cancer patients. Strahlenther Onkol. 2011;187(1):23–31. doi: 10.1007/s00066-010-2139-9.PubMedCrossRefGoogle Scholar
  11. 11.
    Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, A’Hern RP, Sydenham MA, Emson M, Hall E. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12(2):127–36. doi: 10.1016/S1470-2045(10)70290-4.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Parliament MB, Scrimger RA, Anderson SG, Kurien EC, Thompson HK, Field GC, Hanson J. Preservation of oral health-related quality of life and salivary flow rates after inverse-planned intensity-modulated radiotherapy (IMRT) for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004;58(3):663–73. doi: 10.1016/S0360-3016(03)01571-2.PubMedCrossRefGoogle Scholar
  13. 13.
    Tribius S, Bergelt C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: is there a worthwhile quality of life gain? Cancer Treat Rev. 2011;37(7):511–9. doi: 10.1016/j.ctrv.2011.01.004.PubMedCrossRefGoogle Scholar
  14. 14.
    Fang FM, Tsai WL, Lee TF, Liao KC, Chen HC, Hsu HC. Multivariate analysis of quality of life outcome for nasopharyngeal carcinoma patients after treatment. Radiother Oncol. 2010;97(2):263–9. doi: 10.1016/j.radonc.2010.05.022.PubMedCrossRefGoogle Scholar
  15. 15.
    Tong MC, Lee KY, Yuen MT, Lo PS. Perceptions and experiences of post-irradiation swallowing difficulties in nasopharyngeal cancer survivors. Eur J Cancer Care. 2011;20(2):170–8. doi: 10.1111/j.1365-2354.2010.01183.x.CrossRefGoogle Scholar
  16. 16.
    Ku PK, Yuen EH, Cheung DM, Chan BY, Ahuja A, Leung SF, Tong MC, van Hasselt A. Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: symptomatology and videofluoroscopic findings. Laryngoscope. 2007;117(1):142–6. doi: 10.1097/01.mlg.0000248738.55387.44.PubMedCrossRefGoogle Scholar
  17. 17.
    Chang YC, Chen SY, Ting LL, Peng SS, Wang TC, Wang TG. A 2-year follow-up of swallowing function after radiation therapy in patients with nasopharyngeal carcinoma. Arch Phys Med Rehabil. 2011;92(11):1814–9. doi: 10.1016/j.apmr.2011.06.008.PubMedCrossRefGoogle Scholar
  18. 18.
    Tong MC, Lo PS, Wong KH, Yeung RM, van Hasselt CA, Eremenco S, Cella D. Development and validation of the functional assessment of cancer therapy nasopharyngeal cancer subscale. Head Neck. 2009;31(6):738–47. doi: 10.1002/hed.21023.PubMedCrossRefGoogle Scholar
  19. 19.
    Trotti A. Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys. 2000;47(1):1–12. doi: 10.1016/S0360-3016(99)00558-1.PubMedCrossRefGoogle Scholar
  20. 20.
    Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D. Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck. 1999;21(1):1–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P. Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck. 2001;23(5):389–98.PubMedCrossRefGoogle Scholar
  22. 22.
    Perry A, Morris M, Unsworth C, Duckett S, Skeat J, Dodd K, Taylor N, Reilly K. Therapy outcome measures for allied health practitioners in Australia: the AusTOMs. Int J Qual Health Care. 2004;16(4):285–91. doi: 10.1093/intqhc/mzh059.PubMedCrossRefGoogle Scholar
  23. 23.
    Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100(8):678–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Wu CH, Hsiao TY, Ko JY, Hsu MM. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol. 2000;109(3):320–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Pauloski BR, Rademaker AW, Logemann JA, Newman L, MacCracken E, Gaziano J, Stachowiak L. 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. 2006;28(12):1069–76. doi: 10.1002/hed.20459.PubMedCrossRefGoogle Scholar
  26. 26.
    Pauloski BR, Rademaker AW, Lazarus C, Boeckxstaens G, Kahrilas PJ, Logemann JA. Relationship between manometric and videofluoroscopic measures of swallow function in healthy adults and patients treated for head and neck cancer with various modalities. Dysphagia. 2009;24(2):196–203. doi: 10.1007/s00455-008-9192-x.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Eisbruch A, Levendag PC, Feng FY, Teguh D, Lyden T, Schmitz PI, Haxer M, Noever I, Chepeha DB, Heijmen BJ. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40–2. doi: 10.1016/j.ijrobp.2007.04.083.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Dirix P, Nuyts S, Vander Poorten V, Delaere P, Van den Bogaert W. The influence of xerostomia after radiotherapy on quality of life: results of a questionnaire in head and neck cancer. Support Care Cancer. 2008;16(2):171–9. doi: 10.1007/s00520-007-0300-5.PubMedCrossRefGoogle Scholar
  29. 29.
    Sumitsawan Y, Chaiyasate S, Chitapanarux I, Anansuthiwara M, Roongrotwattanasiri K, Vaseenon V, Tooncam H. Late complications of radiotherapy for nasopharyngeal carcinoma. Auris Nasus Larynx. 2009;36(2):205–9. doi: 10.1016/j.anl.2008.04.006.PubMedCrossRefGoogle Scholar
  30. 30.
    Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch-Kinch CA, Nair RG, Napenas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bultzingslowen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010;18(8):1061–79. doi: 10.1007/s00520-010-0837-6.PubMedCrossRefGoogle Scholar
  31. 31.
    Marucci L, Marzi S, Sperduti I, Giovinazzo G, Pinnaro P, Benassi M, Strigari L. Influence of intensity-modulated radiation therapy technique on xerostomia and related quality of life in patients treated with intensity-modulated radiation therapy for nasopharyngeal cancer. Head Neck. 2012;34(3):328–35. doi: 10.1002/hed.21736.PubMedCrossRefGoogle Scholar
  32. 32.
    Jensen SB, Pedersen AM, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NN, Mello AL, Muniz LV, Murdoch-Kinch CA, Nair RG, Napenas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bultzingslowen I, Weikel DS, Elting LS, Spijkervet FK, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer. 2010;18(8):1039–60. doi: 10.1007/s00520-010-0827-8.PubMedCrossRefGoogle Scholar
  33. 33.
    Agulnik M, Epstein JB. Nasopharyngeal carcinoma: current management, future directions and dental implications. Oral Oncol. 2008;44(7):617–27. doi: 10.1016/j.oraloncology.2007.08.003.PubMedCrossRefGoogle Scholar
  34. 34.
    Eisbruch A. Reducing xerostomia by IMRT: what may, and may not be achieved. J Clin Oncol. 2007;25(31):2.CrossRefGoogle Scholar
  35. 35.
    Sandow PL, Hejrat-Yazdi M, Heft MW. Taste loss and recovery following radiation therapy. J Dent Res. 2006;85(7):608–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Maes A, Huygh I, Weltens C, Vandevelde G, Delaere P, Evers G, Van den Bogaert W. De Gustibus: time scale of loss and recovery of tastes caused by radiotherapy. Radiother Oncol. 2002;63(2):195–201.PubMedCrossRefGoogle Scholar
  37. 37.
    Bensadoun RJ, Riesenbeck D, Lockhart PB, Elting LS, Spijkervet FK, Brennan MT. A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer. 2010;18(8):1033–8. doi: 10.1007/s00520-010-0847-4.PubMedCrossRefGoogle Scholar
  38. 38.
    Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia. 2011;. doi: 10.1007/s00455-011-9333-5.PubMedGoogle Scholar
  39. 39.
    Platteaux N, Dirix P, Dejaeger E, Nuyts S. Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia. 2010;25(2):139–52. doi: 10.1007/s00455-009-9247-7.PubMedCrossRefGoogle Scholar
  40. 40.
    Perry A, Skeat J. AusTOMs for speech pathology. Melbourne: La Trobe University; 2004.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Margaret Patterson
    • 1
  • Rowena Brain
    • 1
  • Ronald Chin
    • 3
    • 4
  • David Veivers
    • 1
    • 4
  • Michael Back
    • 1
    • 2
  • Andrew Wignall
    • 1
  • Thomas Eade
    • 1
    • 2
  1. 1.Royal North Shore HospitalSt LeonardsAustralia
  2. 2.University of SydneyCamperdownAustralia
  3. 3.Nepean HospitalKingswoodAustralia
  4. 4.University of SydneyCamperdownAustralia

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