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Dysphagia

Impact on quality of life after radio(chemo)therapy of head and neck cancer

Dysphagie – Einfluss auf die Lebensqualität nach Radio(chemo)therapie bei Kopf-Hals-Tumoren

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Abstract

Background

In the past, xerostomia was considered one of the most important determining factors of quality of life (QoL) after radiotherapy (RT) of the head and neck region. In addition, more recent studies have shown that RT-induced dysphagia has an essential influence on the QoL.

Patients and Methods

Between September 2005 and August 2007, 35 patients with locally advanced squamous cell carcinoma of the head and neck region were included in the prospective study. Patients were treated by IMAT (intensity-modulated arc therapy) or IMRT (intensity-modulated radiotherapy) planned on 3D imaging. A total of 28 patients (80%) received concomitant chemotherapy. The evaluation of QoL (EORTC QLQ - C30, H&N C-35) and toxicities (CTC 2.0) were assessed at the beginning of, during, and after RT as well as up to 12 months after the end of therapy.

Results

At the end of therapy, 86% of the patients experienced difficulties in swallowing (62% CTC II–III°). Twelve months after the end of treatment, 15% still suffered from dysphagia CTC II–III°. Concomitant chemotherapy exacerbated the incidence and gravity of dysphagia, resulting in increasing dietary problems. QoL (EORTC) was significantly affected by dysphagia. In particular, the global state of health and QoL were influenced at the end of treatment (p = 0.033) and at a later stage (p = 0.050).

Conclusion

The findings of this study suggest that more emphasis should be placed on structured clinical diagnostics, therapy, and rehabilitation of deglutition problems. This means in particular to not only spare the parotids while planning the irradiation, but also to take into consideration the important structures for deglutition, like the retropharyngeal muscles.

Zusammenfassung

Hintergrund

Die Xerostomie galt in der Vergangenheit als einer der wichtigsten determinierenden Faktoren der Lebensqualität (LQ) nach Bestrahlung der Kopf-Hals-Region. In aktuellen Studien hatte aber auch die radiogen induzierte Dysphagie einen wesentlichen Einfluss auf die LQ.

Patienten und Methoden

35 Patienten mit lokal fortgeschrittenen Plattenepithelkarzinomen der Kopf-Hals-Region wurden zwischen 09/05 und 08/07 in die prospektive Studie eingeschlossen. Die Bestrahlung (RT) erfolgte 3D-CT-geplant in IMAT- bzw. IMRT-Technik. 28 Patienten (80%) erhielten eine simultane Chemotherapie. Die Evaluation der LQ (EORTC QLQ - C30, H&N C-35) und der Toxizitäten (CTC 2.0) erfolgte vor Beginn, während und im Anschluss an die RT sowie im weiteren Verlauf bis zu 12 Monaten nach Abschluss der Therapie.

Ergebnisse

Nach Abschluss der Therapie gaben 86% der Patienten Schluckbeschwerden an (62% CTC II–III°). 12 Monate nach Behandlungsende litten noch 15% der Patienten an Dysphagie CTC II–III°. Die Gabe einer simultanen Chemotherapie beeinflusste die Inzidenz und Stärke der auftretenden Dysphagie und führte somit zu verstärkten Ernährungsproblemen. Es zeigte sich eine deutliche Beeinträchtigung der LQ (EORTC) durch die radiogen induzierte Dysphagie. Insbesondere der globale Gesundheitszustand und die globale LQ wurden sowohl nach Abschluss der Behandlung (p = 0,033) als auch im weiteren Verlauf (p = 0,050) negativ beeinflusst.

Schlussfolgerung

Die Ergebnisse dieser Arbeit sollten Anlass sein, zukünftig einer strukturierten Diagnostik, Therapie und Rehabilitation von Schluckstörungen mehr Bedeutung zukommen zu lassen und insbesondere bei der Bestrahlungsplanung nicht nur Wert auf die Schonung der Parotiden, sondern auch auf die der am Schluckakt beteiligten Strukturen, wie z. B. der retropharyngealen Muskulatur, zu legen.

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Authors and Affiliations

  1. Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany

    Julia Maurer, Matthias Hipp & Oliver Kölbl

  2. Department of Radiotherapy, Hospital St. Elisabeth Straubing, Straubing, Germany

    Christof Schäfer

  3. Department of Radiotherapy, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    Julia Maurer

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  1. Julia Maurer
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  4. Oliver Kölbl
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Correspondence to Julia Maurer.

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Maurer, J., Hipp, M., Schäfer, C. et al. Dysphagia. Strahlenther Onkol 187, 744–749 (2011). https://doi.org/10.1007/s00066-011-2275-x

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