title: How does radiotherapy impact swallowing function in nasopharynx and oropharynx cancer? Short-term results of a prospective study.
abstract: The objective of this study is to report the initial results of a prospective trial assessing instrumental deglutition function in nasopharynx and oropharynx cancers after radio or chemoradiotherapy using intensity-modulated radiotherapy (IMRT). IMRT was delivered aiming to spare the swallowing organ at risk (SWOARs) for Stage II-IV naso- and oropharynx cancer. Objective instrumental assessment included videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngeal-oesophageal scintigraphy (OPES) at baseline and at 1 month after radiotherapy. Dysphagia parameter scores were calculated at each exam after liquid (L) and semi-liquid (SL) bolus intake: pre-deglutition penetration, aspiration, pharyngeal transit time (PTT) and hypopharyngeal retention index (HPRI). Overall, 20 patients (6 nasophaynx and 14 oropharynx) completed treatment and instrumental assessment after 1 month. Comparison between pre- and post-treatment HPRI score values showed a significant worsening in both FEES-L (p = 0.021) and SL (p = 0.02) and at VFS-L (p = 0.008) and SL (p = 0.005). Moreover, a relationship between HPRI worsening at FEES-L and FEES-SL (p = 0.005) as well as at VFS-L and VFS-SL (p < 0.001) was observed. PTT was not significantly affected by radiotherapy (p > 0.2). Only a few patients experienced pre-deglutition penetration (1 patient with base of tongue cancer at FEES-L and SL) and aspiration (1 patient with nasopharynx cancer at OPES-L and FEES-SL) after radiotherapy. Our early results showed that IMRT-SWOARs sparing caused a significant increase in the post-deglutition HPRI score. Longer follow-up will be necessary to evaluate if the increase of HPRI is related to a high risk of developing late aspiration.
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Ursino
authors.affiliation: First Otorhinolaryngology Unit, University Hospital Cisanello, Pisa, Italy;
authors.forename: V
authors.initials: V
authors.lastname: Seccia
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Cocuzza
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Ferrazza
authors.affiliation: First Otorhinolaryngology Unit, University Hospital Cisanello, Pisa, Italy;
authors.forename: T
authors.initials: T
authors.lastname: Briganti
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: F
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: L
authors.initials: L
authors.lastname: Fatigante
authors.affiliation: Department of Radiology, University Hospital Cisanello, Pisa, Italy;
authors.forename: P
authors.initials: P
authors.lastname: Giusti
authors.affiliation: Department of Nuclear Medicine, University Hospital S. Chiara, Pisa,Italy;
authors.forename: M
authors.initials: M
authors.lastname: Grosso
authors.affiliation: Department of Nuclear Medicine, University Hospital S. Chiara, Pisa,Italy;
authors.forename: L
authors.initials: L
authors.lastname: Locantore
authors.affiliation: Biostatistical Consulting, Department of Oncology, University Hospital S.Chiara, Pisa, Italy;
authors.forename: R
authors.initials: R
authors.lastname: Morganti
authors.affiliation: Otorhinolaryngology-Audiology-Phoniatric Unit, University Hospital Cisanello, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nacci
authors.affiliation: First Otorhinolaryngology Unit, University Hospital Cisanello, Pisa, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Sellari Franceschini
authors.affiliation: Department of Radiation Oncology, University Hospital S. Chiara, Pisa, Italy;
authors.forename: F
authors.initials: F
authors.lastname: Paiar
authors.affiliation: Department of Radiology, University Hospital Cisanello, Pisa, Italy;
authors.forename: D
authors.initials: D
authors.lastname: Caramella
authors.affiliation: Otorhinolaryngology-Audiology-Phoniatric Unit, University Hospital Cisanello, Pisa, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Fattori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy*; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D013997:Time Factors
keywords: Deglutition; Fiberoptic endoscopic swallowing evaluation; Intensity and modulated radiotherapy; Videofluoroscopy