title: Evolution of chronic dysphagia following treatment for head and neck cancer.
abstract: We would like to assess the evolution of chronic dysphagia (1 year or more) following treatment for head and neck cancer. Modified barium swallow (MBS) examinations were performed in cancer-free patients who complained of dysphagia following treatment for head and neck cancer. The severity of the dysphagia was graded on a scale of 1-7. Each patient had at least 2 MBS. Severity of dysphagia was compared between the first and last MBS study to determine whether the swallowing dysfunction had returned to normal. Patients with complaint of dysphagia and normal MBS also underwent a regular barium swallow to assess the structural integrity of the pharynx and esophagus. Between 1996 and 2001, 25 patients with dysphagia underwent repeat MBS following treatment. Swallowing dysfunction did not return to normal in the majority of the patients. At a median time of 26 months following treatment (range 15-82 months), only two patient (8%) had normalization of the swallowing. The severity of dysphagia decreased in eight patients (32%), remained unchanged in 12 patients (48%), and worsened in five patients (20%). Eight patients (32%) still had aspiration problems at 12-83 months following treatment. Six patients (24%) required dilation because of pharyngeal stenosis. Three patients who required dilation had improvement of the dysphagia severity. Chronic dysphagia is a relentless process possibly due to excessive scarring. Patients with chronic dysphagia are at risk of malnutrition, and aspiration. Management of chronic dysphagia requires a team approach with nutritional support, psychological counseling, dilation, and tube feedings when indicated.
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Radiation Oncology Service, VA North Texas Health Care System, 4500 S Lancaster Road, Dallas, TX 75216, USA. NamPhong.Nguyen@med.va.gov
authors.forename: Nam P
authors.initials: NP
authors.lastname: Nguyen
authors.forename: Candace C
authors.initials: CC
authors.lastname: Moltz
authors.forename: Cheryl
authors.initials: C
authors.lastname: Frank
authors.forename: Paul
authors.initials: P
authors.lastname: Vos
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Smith
authors.forename: Ulf
authors.initials: U
authors.lastname: Karlsson
authors.forename: Ly M
authors.initials: LM
authors.lastname: Nguyen
authors.forename: Sue
authors.initials: S
authors.lastname: Rose
authors.forename: Suresh
authors.initials: S
authors.lastname: Dutta
authors.forename: Sabah
authors.initials: S
authors.lastname: Sallah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents