title: Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence.
abstract: OBJECTIVE
  We would like to assess the prevalence of aspiration before and following chemoradiation for head and neck cancer.
  
  
  METHODS
  We reviewed retrospectively the Modified Barium Swallow (MBS) in 63 patients who underwent concurrent chemotherapy and radiation for head and neck cancer. MBS was performed prior to treatment to determine the need for immediate gastrostomy tube placement. MBS was repeated following treatment to assess the safety of oral feeding prior to removal of tube feeding. All patients were cancer free at the time of the swallowing study. No patient had surgery. Dysphagia severity was graded on a scale of 1-7. Tube feedings were continued if patients were diagnosed to have severe aspiration (grade 6-7) or continued weight loss. Patients with abnormal swallow (grade 3-7) received swallowing therapy following MBS.
  
  
  RESULTS
  Before treatment, there were 18 grade 1, 18 grade 2, 9 grade 3, 8 grade 4, 3 grade 5, 3 grade 6, and 4 grade 7. Following chemoradiation, at a median follow-up of 2 months (1-10 months), one patient had grade 1, eight patients had grade 2, nine patients had grade 3, eight patients had grade 4, 13 patients had grade 5, seven patients had grade 6, and 11 patients had grade 7. Six patients died from aspiration pneumonia (one before, three during, and two post-treatment), and did not have the second MBS. Overall, 37/63 (59%) patients developed aspiration, six of them (9%) fatal. If we excluded the 10 patients who had severe aspiration at diagnosis and the six patients who died from pneumonia, the prevalence of severe aspiration was 33% (21/63).
  
  
  CONCLUSIONS
  Aspiration remained a significant morbidity following chemoradiation for head and neck cancer. Its prevalence is underreported in the literature because of its often silent nature. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, and for rehabilitation.
authors.affiliation: Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75216, USA. NamPhong.Nguyen@yahoo.com
authors.forename: Nam P
authors.initials: NP
authors.lastname: Nguyen
authors.forename: Cheryl
authors.initials: C
authors.lastname: Frank
authors.forename: Candace C
authors.initials: CC
authors.lastname: Moltz
authors.forename: Paul
authors.initials: P
authors.lastname: Vos
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Smith
authors.forename: Prabhakar V
authors.initials: PV
authors.lastname: Bhamidipati
authors.forename: Ulf
authors.initials: U
authors.lastname: Karlsson
authors.forename: Phuc D
authors.initials: PD
authors.lastname: Nguyen
authors.forename: Alan
authors.initials: A
authors.lastname: Alfieri
authors.forename: Ly M
authors.initials: LM
authors.lastname: Nguyen
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Wayne
authors.initials: W
authors.lastname: Chan
authors.forename: Sue
authors.initials: S
authors.lastname: Rose
authors.forename: Sabah
authors.initials: S
authors.lastname: Sallah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001464:Barium / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D001464:Barium