Dysphagia after chemoradiation: analysis by modified barium swallow.
OBJECTIVE
We sought to describe the findings of modified barium swallow study after chemoradiation in patients with head and neck cancer and to correlate these findings with clinical variables, including gastrostomy tube dependence and clinical pneumonia.


METHODS
We retrospectively reviewed 49 patients at a tertiary care center who underwent modified barium swallow study for dysphagia after chemoradiation.


RESULTS
Patients with nonlaryngeal lesions had increased cricopharyngeal impairment (27.8% versus 0.0%; p = .04). Patients who underwent concomitant chemotherapy had increased epiglottic changes relative to those who had radiotherapy alone (66.7% versus 30.8%; p = .05). Clinical pneumonia developed in 31.9% of the patients, and 79.6% required gastrostomy tube placement for a mean duration of 18.1 months.


CONCLUSIONS
Chemoradiation effects deglutition at multiple levels. A large percentage of patients will develop pneumonia and feeding tube dependence. This study is among the largest to correlate the results of modified barium swallow studies to clinical variables in this patient population. This study highlights the significant incidence of gastrostomy tube dependence and pneumonia in these patients.
Bleier
Benjamin S
BS
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, USA.
Levine
Marc S
MS
Mick
Rosemarie
R
Rubesin
Stephen E
SE
Sack
Stephen Z
SZ
McKinney
Kibwei
K
Mirza
Natasha
N
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001466:Barium Sulfate / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D003287:Contrast Media / Q000008:administration & dosage*; D003679:Deglutition / Q000187:drug effects / Q000528:radiation effects; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D011379:Prognosis; D011859:Radiography; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D003287:Contrast Media; D001466:Barium Sulfate