title: Strategies to reduce long-term postchemoradiation dysphagia in patients with head and neck cancer: an evidence-based review.
abstract: BACKGROUND
  Swallowing dysfunction following chemoradiation for head and neck cancer is a major cause of morbidity and reduced quality of life. This review discusses 3 strategies that may improve posttreatment swallowing function.
  
  
  METHODS
  The literature was assessed by a multiauthor team that produced evidence-based recommendations.
  
  
  RESULTS
  (1) Prospective and randomized studies with small cohorts show a trend toward benefits for a preventative exercise program addressing oral and pharyngeal structures. (2) Prospective and retrospective data indicate that better swallowing outcomes are likely when nasogastric tubes are used in preference to gastrostomy tubes to supplement enteral nutrition during chemoradiation. (3) Emerging prospective data with mature results on small cohorts support the hypothesis that radiation dose restriction to swallowing structures using intensity-modulated radiation therapy techniques leads to better swallow outcomes.
  
  
  CONCLUSIONS
  This study discusses 3 strategies for improving swallow-related outcomes in patients undergoing chemoradiation for head and neck cancer and identifies areas for future research.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom.
authors.forename: Vinidh
authors.initials: V
authors.lastname: Paleri
authors.forename: Justin W G
authors.initials: JW
authors.lastname: Roe
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.forename: June
authors.initials: J
authors.lastname: Corry
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D059248:Chemoradiotherapy; D003680:Deglutition Disorders / Q000517:prevention & control / Q000534:rehabilitation*; D004750:Enteral Nutrition; D005081:Exercise Therapy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016896:Treatment Outcome
keywords: IMRT; chemoradiation; dysphagia; swallowing exercise; tube feeding