title: Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer - a systematic review.
abstract: OBJECTIVE
  A systematic review to establish what evidence is available for swallowing outcomes following IMRT for head and neck cancer.
  
  
  METHODS
  Online electronic databases were searched to identify papers published in English from January 1998 to December 2009. Papers were independently appraised by two reviewers for methodological quality, method of swallowing evaluation and categorized according to the World Health Organisation's International Classification of Health Functions. The impact of radiation dose to dysphagia aspiration risk structures (DARS) was also evaluated.
  
  
  RESULTS
  Sixteen papers met the inclusion criteria. The literature suggests that limiting the radiation dose to certain structures may result in favourable swallowing outcomes. Methodological limitations included variable assessment methods and outcome measures and heterogeneity of patients. There are only limited prospective data, especially where pre-treatment measures have been taken and compared to serial post-treatment assessment.
  
  
  CONCLUSIONS
  Few studies have investigated the impact of IMRT on swallow function and the impact on everyday life. Initial studies have reported potential benefits but are limited in terms of study design and outcome data. Further well designed, prospective, longitudinal swallowing studies including multidimensional evaluation methods are required to enable a more comprehensive understanding of dysphagia complications and inform pre-treatment counselling and rehabilitation planning.
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London SW3 6JJ, United Kingdom. justin.roe@nhs.net
authors.forename: Justin W G
authors.initials: JW
authors.lastname: Roe
authors.forename: Paul N
authors.initials: PN
authors.lastname: Carding
authors.forename: Raghav C
authors.initials: RC
authors.lastname: Dwivedi
authors.forename: Rehan A
authors.initials: RA
authors.lastname: Kazi
authors.forename: Peter H
authors.initials: PH
authors.lastname: Rhys-Evans
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000523:psychology / Q000532:radiotherapy*; D003680:Deglutition Disorders / Q000209:etiology* / Q000523:psychology; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology; D011832:Radiation Injuries / Q000150:complications; D011879:Radiotherapy Dosage / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted; D016896:Treatment Outcome