Ann Rehabil Med.  2016 Dec;40(6):1100-1107. 10.5535/arm.2016.40.6.1100.

Change of Swallowing in Patients With Head and Neck Cancer After Concurrent Chemoradiotherapy

Affiliations
  • 1Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Korea. drjeesungju@cnuh.co.kr
  • 2Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Korea.

Abstract


OBJECTIVE
To evaluate the functional characteristics of swallowing and to analyze the parameters of dysphagia in head and neck cancer patients after concurrent chemoradiotherapy (CCRT).
METHODS
The medical records of 32 patients with head and neck cancer who were referred for a videofluoroscopic swallowing study from January 2012 to May 2015 were retrospectively reviewed. The patients were allocated by duration after starting CCRT into early phase (<1 month after radiation therapy) and late phase (>1 month after radiation therapy) groups. We measured the modified penetration aspiration scale (MPAS) and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (ASHA-NOMS). The oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were recorded to assess the swallowing physiology.
RESULTS
Among 32 cases, 18 cases (56%) were of the early phase. In both groups, the most common tumor site was the hypopharynx (43.75%) with a histologic type of squamous cell carcinoma (75%). PTT was significantly longer in the late phase (p=0.03). With all types of boluses, except for soup, both phases showed a statistically significant difference in MPAS results. The mean ASHA-NOMS level for the early phase was 5.83±0.78 and that for the late phase was 3.79±1.80, with statistical significance (p=0.01). The PTT and ASHA-NOMS level showed a statistically significant correlation (correlation coefficient=-0.52, p=0.02). However, it showed no relationship with the MPAS results.
CONCLUSION
The results of our study suggest that in the late phase that after CCRT, the OTT, PDT, and PTT were longer than in the early phase and the PTT prolongation was statistically significant. Therefore, swallowing therapy targeting the pharyngeal phase is recommended after CCRT.

Keyword

Deglutition disorders; Head and neck neoplasms; Chemoradiotherapy

MeSH Terms

American Speech-Language-Hearing Association
Carcinoma, Squamous Cell
Chemoradiotherapy*
Deglutition Disorders
Deglutition*
Head and Neck Neoplasms*
Head*
Humans
Hypopharynx
Medical Records
Physiology
Retrospective Studies

Figure

  • Fig. 1 Videofluoroscopic swallowing study lateral plane view. Each image included the lips anteriorly to the vertebrae posteriorly, and the soft palate superiorly to the 6th cervical vertebra inferiorly.

  • Fig. 2 Quantitative data of the swallowing physiology. People in the late status group showed a tendency for longer oral transit time (OTT) and pharyngeal delay time (PDT) than those in the early status group. Pharyngeal transit time (PTT) was statistically longer in the late status group (*p<0.05).

  • Fig. 3 Modified penetration aspiration scale (MPAS) for 5 different boluses between 2 phases. In all type of boluses, except soup, both groups showed a statistically significant difference in the MPAS results. That is, the late phase MPAS results were higher than those of the early phase.


Cited by  1 articles

Acoustic Voice Analysis in Patients with Penetration/Aspiration Via Videofluoroscopic Swallowing Study
Young Ae Kang, Sung Ju Jee, Bon Seok Koo
Korean J Otorhinolaryngol-Head Neck Surg. 2017;60(9):454-462.    doi: 10.3342/kjorl-hns.2017.00213.


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