, Volume 33, Issue 5, pp 691–706 | Cite as

Longitudinal Evaluation of Swallowing with Videofluoroscopy in Patients with Locally Advanced Head and Neck Cancer After Chemoradiation

  • Ekaterini XinouEmail author
  • Ioannis Chryssogonidis
  • Anna Kalogera-Fountzila
  • Dimitra Panagiotopoulou-Mpoukla
  • Athanasia Printza
Original Article


The aim of this study was to investigate the prevalence, severity, and pattern of evolution of swallowing impairments encountered in head and neck cancer (HNC) patients before and after chemoradiation (CRT) with videofluoroscopy of swallowing study (VFSS), using the modified barium swallow impairment profile (MBSImP) protocol and scoring system, and to determine the appropriate time points in which these patients should undergo VFSS post-CRT. A prospective cohort of 69 patients with locally advanced HNC underwent VFSS with the MBSImP protocol at 5 evaluation points: pre-CRT, and 1, 3, 6, and 12 months post-CRT. VFSS was scored with MBSImP, penetration–aspiration scale (PAS), and swallowing performance status (SPS) scale. Statistical analysis was performed only for the 12-month disease-free subset of patients. MBSImP, PAS, and SPS scale scores reached their peak at 3 months post-CRT and improved at 6–12 months, but without returning at pre-treatment levels. Base of tongue retraction, initiation of pharyngeal swallow, epiglottic movement, laryngeal vestibule closure, and laryngeal elevation were the most frequently observed impaired MBSImP components. Epiglottic movement significantly improved (p = 0.009) and laryngeal vestibule closure significantly deteriorated (p = 0.042) over time (Friedman test). Severe swallowing deficits and high aspiration rates are observed in HNC patients pre-CRT, which further deteriorate post-CRT, peak at 3 months, and despite slight improvement, persist over time. We suggest that these patients, regardless of the presence of subjective dysphagia, should undergo VFSS both before and 3 months post-CRT, and also if possible, 1 month post-CRT, in order to facilitate implementation of early swallowing rehabilitation.


Videofluoroscopy of swallowing Modified barium swallow MBSImP Dysphagia Head and neck cancer Chemoradiotherapy Deglutition Deglutition disorders 



We thank Professor Bonnie Martin-Harris, Professor Nicholas Stergiou, and Dr. Georgia Lazaraki for assistance with language editing and comments that greatly improved the manuscript.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

Ekaterini Xinou, Ioannis Chryssogonidis, Anna Kalogera-Fountzila, Dimitra Panagiotopoulou-Mpoukla and Athanasia Printza declares that they have no conflict of interest.

Ethical Approval

All procedures performed this study 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. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (DOCX 18 kb)
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Supplementary material 4 (DOCX 15 kb)
455_2018_9889_MOESM5_ESM.docx (19 kb)
Supplementary material 5 (DOCX 18 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyTheagenio Cancer HospitalThessaloníkiGreece
  2. 2.Department of RadiologyAristotle University of Thessaloniki School of Medicine, AHEPA University HospitalThessaloníkiGreece
  3. 3.First Department of Oto-rhino-laryngologyAristotle University of Thessaloniki School of Medicine, AHEPA University HospitalThessaloníkiGreece

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