title: Objective assessment of swallowing function after definitive concurrent (chemo)radiotherapy in patients with head and neck cancer.
abstract: The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration-aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n = 34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P = 0.05), and large tumor volume (P = 0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, 400012, India. jaiprakash.agarwal@rediffmail.com
authors.forename: Jaiprakash
authors.initials: J
authors.lastname: Agarwal
authors.forename: Vijay
authors.initials: V
authors.lastname: Palwe
authors.forename: Debnarayan
authors.initials: D
authors.lastname: Dutta
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Sarbani Ghosh
authors.initials: SG
authors.lastname: Laskar
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.forename: Prathamesh
authors.initials: P
authors.lastname: Pai
authors.forename: Devendra
authors.initials: D
authors.lastname: Chaukar
authors.forename: Anil K
authors.initials: AK
authors.lastname: D'Cruz
authors.forename: Suyash
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Gurmit
authors.initials: G
authors.lastname: Baccher
authors.forename: Shyam Kishore
authors.initials: SK
authors.lastname: Shrivastava
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D003679:Deglutition / Q000187:drug effects / Q000528:radiation effects*; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged