Dysphagia-Related Quality of Life of Patients with Cancer in the Oropharynx: An Advantage for Brachytherapy?

In organ preservation therapy, for cancer in the head and neck, over the years a number of investigators have noted a signifi cant increase in dysphagia, defi ned as swallowing problems that most likely relate to more aggressive treatment regimes used in order to obtain better tumor control rates. The aggressive nature of the treatment modalities is exemplifi ed by high doses of radiation and/or (accelerated) fractionation regimens, with or without (concomitant) chemotherapy (Levendag et al. 2004). Xerostomia has been well documented in patients treated with chemotherapy (CHT) and/or radiation. It has been argued that the degree of xerostomia corresponds with the amount of dysphagia experienced by the patient (Logemann et al. 2001, 2003). To defi ne potential rehabilitation strategies, it is important to investigate fi rst the anatomical structures and functionality of the swallowing apparatus. Examples of preventative measures are the pre- and posttreatment exercises and/or the introduction of Therabite (Burkhead et al. 2006; Kulbersh et al. 2006). Few studies have examined the association of dysphagia with the location of the primary tumor site (Pauloski et al. 2000, 2002).

This chapter analyses the response to validated QOL questionnaires in search of (severe) late side effects, such as swallowing disorders and xerostomia, in patients with oropharyngeal cancers treated between 1991 and 2005 in a single institution (Erasmus MC). The patient retrieval for the current analysis consisted of patients with tonsillar fossa and/or soft palate (TF and/or SP) or base-of-tongue (BOT) tumors treated by radiation therapy (RT). Over time the primary tumor was boosted by various RT techniques, that is, by either a parallel-opposed (P-O) fi eld confi guration, or by 3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), or brachytherapy (BT). A treatment regime using conventional 2 Gy/day fractionation, combined with a BT boost, has been applied in our institute by far the most over a great number of years (1991– 2008) for various reasons: With regard to tumor control, HDR/PDR fractionation is given in an accelerated fashion with intrinsic dose escalation. A high confor-mality is obtained because of an accurate CTV delineation, no PTV margin (because catheters move with movement of target area), and rapid dose fall-off. The invasiveness of the procedure, the need for albeit some dexterity, the logistics in the OR, and patients being medically unfi t for any type of surgical procedure are some of the disadvantages of BT. This chapter reports in particular those patients treated with BT.