, Volume 34, Issue 1, pp 52–62 | Cite as

Predictors of Patient-Reported Dysphagia Following IMRT Plus Chemotherapy in Oropharyngeal Cancer

  • Ester OrlandiEmail author
  • Rosalba Miceli
  • Gabriele Infante
  • Aurora Mirabile
  • Daniela Alterio
  • Maria Cossu Rocca
  • Nerina Denaro
  • Riccardo Vigna-Taglianti
  • Annamaria Merlotti
  • Antonio Schindler
  • Nicole Pizzorni
  • Carlo Fallai
  • Lisa Licitra
  • Paolo Bossi
Original Article


The aim of this cross-sectional study is to evaluate the factors associated with patient-reported dysphagia in patients affected by locally advanced oropharyngeal cancer (OPC) treated with definitive intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy (CHT), with or without induction CHT. We evaluated 148 OPC patients treated with IMRT and concurrent CHT, without evidence of disease and who had completed their treatment since at least 6 months. At their planned follow-up visit, patients underwent clinical evaluation and completed the M.D. Anderson dysphagia inventory (MDADI) questionnaire. The association between questionnaire composite score (MDADI-CS) and different patients’ and tumor’s characteristics and treatments (covariates) was investigated by univariable and multivariable analyses, the latter including only covariates significant at univariable analysis. With a median time from treatment end of 30 months [range 6–74 months, interquartile range (IQR) 16–50 months], the median (IQR) MDADI-CS was 72 (63–84). The majority of patients (82.4%) had a MDADI-CS ≥ 60. At multivariable analysis, female gender, human papilloma virus (HPV)-negative status, and moderate and severe clinician-rated xerostomia were significantly associated with lower MDADI-CS. Patient-perceived dysphagia was satisfactory or acceptable in the majority of patients. HPV status and xerostomia were confirmed as important predictive factors for swallowing dysfunction after radiochemotherapy. Data regarding female gender are new and deserve further investigation.


Oropharyngeal carcinoma Long-term dysphagia MDADI score Human papilloma virus Xerostomia 



Editorial assistance for the preparation of this manuscript was provided by Luca Giacomelli, PhD, Ambra Corti, and Sara Parodi, PhD; this assistance was supported by internal funds.


No funding was received for the preparation of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The Authors declare that they have no conflict of interest.

Ethical Approval

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

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

Supplementary material

455_2018_9913_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

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

Authors and Affiliations

  • Ester Orlandi
    • 1
    Email author
  • Rosalba Miceli
    • 2
  • Gabriele Infante
    • 2
  • Aurora Mirabile
    • 3
  • Daniela Alterio
    • 4
  • Maria Cossu Rocca
    • 5
  • Nerina Denaro
    • 6
  • Riccardo Vigna-Taglianti
    • 7
  • Annamaria Merlotti
    • 7
  • Antonio Schindler
    • 8
  • Nicole Pizzorni
    • 8
  • Carlo Fallai
    • 1
  • Lisa Licitra
    • 3
  • Paolo Bossi
    • 3
  1. 1.Radiotherapy 2 UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  2. 2.Unit of Medical Statistics, Biometry and BioinformaticsFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  3. 3.Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
  4. 4.Department of Radiotherapy, Advanced Radiotherapy CenterEuropean Institute of OncologyMilanItaly
  5. 5.Medical Oncology Division of Urogenital and Head and Neck TumoursEuropean Institute of OncologyMilanItaly
  6. 6.Department of OncologyAzienda Ospedaliera Santa Croce e CarleCuneoItaly
  7. 7.Department of Radiation OncologyAzienda Ospedaliera Santa Croce and CarleCuneoItaly
  8. 8.Phoniatric Unit, Department of Biomedical and Clinical Sciences, Ospedale SaccoUniversity of MilanMilanItaly

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