title: Swallowing function following postchemoradiotherapy neck dissection: review of findings and analysis of contributing factors.
abstract: OBJECTIVE
  This study assesses swallowing function following chemoradiotherapy and neck dissection in head and neck cancer patients and investigates clinical, treatment, and neck dissection factors associated with dysphagia.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Eighty-eight patients undergoing neck dissection after chemoradiotherapy for advanced head and neck cancer were reviewed. Dysphagia outcome measures included weight loss, diet, gastrostomy tube (GT) dependency,and video swallow findings of aspiration or stenosis. In addition,the researchers created a Diet/GT Scale, with scores ranging from 1 to 5. Univariate and multivariate analysis of clinical, treatment, or neck dissection factors potentially associated with dysphagia outcome measures was undertaken.
  
  
  RESULTS
  Peak mean weight loss was 17% at 6 months after chemoradiotherapy. At 12 months, a soft/regular diet was taken by 78 of 88 patients (89%), and only 1 of 88 patients (1%)was nil per os. Gastrostomy tube dependence at 6, 12, and 24 months was 53%, 25%, and 10%, respectively. The Diet/GT score was 5 (gastrostomy tube removed and soft/regular diet)for 47% at 6 months, 74% at 12 months, and 89% at 24 months.Multivariate analyses revealed that higher tumor stage was associated with a lower Diet/GT score at 12 months (P = .02)and gastrostomy dependence at 12 months (P = .01) and 24 months (P = .04).
  
  
  CONCLUSIONS
  Despite the addition of neck dissection to chemoradiotherapy,nearly all patients took a soft or regular diet and reached a Diet/GT score of 5, and only 1% remained nil per os. A higher tumor stage is associated with a lower Diet/GT score and gastrostomy tube dependency beyond 12 months.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Chapuy
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
authors.forename: Anna
authors.initials: A
authors.lastname: Snavely
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
authors.forename: Charles M
authors.initials: CM
authors.lastname: Norris
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome