Evaluation and management of swallowing dysfunction following chemoradiation for head and neck cancer.
OBJECTIVE
Concurrent chemoradiation offers excellent local control and survival for patients with locally advanced head and neck cancer while allowing anatomic organ preservation. Treatment toxicity is significant, however, often resulting in long-term dysphagia and aspiration. We review the prevalence of post-treatment swallowing dysfunction, describe current thinking about its pathogenesis and management, and signal possible directions for future research.


RESULTS
Apoptosis from chemoradiation induces abnormal motility of the upper aerodigestive tract, resulting in stasis of the bolus in all phases of the swallow, and resulting in aspiration when the larynx is not protected during swallow. Long-term scarring may result in stenosis of the upper digestive tract. Recent findings suggest the role of transforming growth factor beta 1 in the pathogenesis of normal tissue damage and late scarring induced by radiation. Aspiration is often silent, and therefore a modified barium swallow or videofluoroscopy are required for its diagnosis. Swallowing therapy may improve swallowing efficiency and reduce the aspiration rate, and should be started immediately.


CONCLUSIONS
Successful management of swallowing dysfunction following chemoradiation is a complex undertaking requiring a team approach. Collaboration among different specialists (physicians, speech pathologist, dietitian, and psychologists) remains the key to a desirable outcome.
Nguyen
Nam P
NP
Radiation Oncology Department, University of Arizona, Tucson, Arizona 85724, USA. NamPhong.Nguyen@yahoo.com
Smith
Herbert J
HJ
Sallah
Sabah
S
D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012720:Severity of Illness Index; D053773:Transforming Growth Factor beta1 / Q000097:blood
D053773:Transforming Growth Factor beta1