Pharyngeal transport dysfunction consequent to an organ-sparing protocol.
OBJECTIVE
To investigate the effects of a protocol of concomitant intravenous hydroxyurea and hyperfractionated, accelerated, external-beam radiation therapy on the swallowing mechanism of patients with advanced-stage head and neck cancer.


METHODS
Posttreatment videofluoroscopic swallow function studies, using images of single-bolus swallows of low-density liquid barium, were analyzed in real time, slow motion, and frame by frame using an integrated system that allows objective analysis of video recordings through image processing and digitization (Kay Elemetrics Computerized Swallowing Station). Radiological descriptors were used for pharyngeal transport abnormalities, and temporal measures were obtained of structural movements.


METHODS
Academic, tertiary care, referral medical center.


METHODS
Fifteen consecutive patients with previously untreated, stages III and IV, nonmetastatic squamous cell carcinoma of the head and neck who underwent a phase 1 study of prolonged infusion hydroxyurea therapy in combination with hyperfractionated, accelerated external-beam radiation therapy for their disease.


RESULTS
All patients had anterior pharyngeal segment dysfunction, characterized by no epiglottic movement and slowed laryngeal motility (1.011 +/- 0.379 seconds [mean +/- SD). Anterior pharyngeal dysfunction was more severe in patients with primary tumors of the hypopharynx than in those with cancer of the oropharynx. Twelve (80%) of our patients demonstrated posterior pharyngeal segment dysfunction characterized by impaired pharyngeal constrictor motility. All 15 patients displayed pharyngeal stage abnormalities that limited bolus transport and clearance.


CONCLUSIONS
Severe pharyngeal physiological abnormalities were present that led to impaired bolus transport and that were frequent and debilitating consequences of this organ-sparing protocol. Long-term follow-up of this group will be required to assess the permanence of the abnormalities.
Kotz
T
T
Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center and the Albert Einstein Cancer Center, Bronx, NY 10467, USA.
Abraham
S
S
Beitler
J J
JJ
Wadler
S
S
Smith
R V
RV
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy; D017321:Clinical Trials, Phase I as Topic; D003679:Deglutition; D005260:Female; D005471:Fluoroscopy; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000503:physiopathology*; D011446:Prospective Studies; D011879:Radiotherapy Dosage
D000970:Antineoplastic Agents; D006918:Hydroxyurea