title: Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer.
abstract: OBJECTIVE
  Assessment of long term (10-years+) swallowing function, mouth opening, and quality of life (QoL) in head and neck cancer (HNC) patients treated with chemo-radiotherapy (CRT) for advanced stage IV disease.
  
  
  METHODS
  Twenty-two disease-free survivors, participating in a multicenter randomized clinical trial for inoperable HNC (1999-2004), were evaluated to assess long-term morbidity. The prospective assessment protocol consisted of videofluoroscopy (VFS) for obtaining Penetration Aspiration Scale (PAS) and presence of residue scores, Functional Oral Intake Scale (FOIS) scores, maximum mouth opening measurements, and (SWAL-QOL and study-specific) questionnaires.
  
  
  RESULTS
  At a median follow-up of 11-years, 22 patients were evaluable for analysis. Ten patients (46%) were able to consume a normal oral diet without restrictions (FOIS score 7), whereas 12 patients (54%) had moderate to serious swallowing issues, of whom 3 (14%) were feeding tube dependent. VFS evaluation showed 15/22 patients (68%) with penetration and/or aspiration (PAS⩾3). Fifty-five percent of patients (12/22) had developed trismus (mouth opening⩽35mm), which was significantly associated with aspiration (p=.011). Subjective swallowing function (SWAL-QOL score) was impaired across almost all QoL domains in the majority of patients. Patients treated with IMRT showed significantly less aspiration (p=.011), less trismus (p=.035), and less subjective swallowing problems than those treated with conventional radiotherapy.
  
  
  CONCLUSIONS
  Functional swallowing and mouth opening problems are substantial in this patient cohort more than 10-years after organ-preservation CRT. Patients treated with IMRT had less impairment than those treated with conventional radiotherapy.
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: S A C
authors.initials: SA
authors.lastname: Kraaijenga
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: I M
authors.initials: IM
authors.lastname: Oskam
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van der Molen
authors.affiliation: The Netherlands Cancer Institute, Department of Radiation Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Hamming-Vrieze
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands. Electronic address: f.hilgers@nki.nl.
authors.forename: F J M
authors.initials: FJ
authors.lastname: Hilgers
authors.affiliation: The Netherlands Cancer Institute, Department of Head and Neck Oncology and Surgery, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Institute of Phonetic Sciences/ACLC, University of Amsterdam, Spuistraat 210, 1012 VT Amsterdam, The Netherlands; Academic Medical Center, Department of Oral and Maxillofacial Surgery, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
authors.forename: M W M
authors.initials: MW
authors.lastname: van den Brekel
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014313:Trismus / Q000453:epidemiology* / Q000209:etiology
keywords: Deglutition disorders; Dysphagia; Head and neck cancer; Intensity modulated radiotherapy; Long-term effects; Trismus