Swallowing Disorders in Head and Neck Cancer Patients Treated With Radiotherapy and Adjuvant Chemotherapy

TLDR

Swallowing dysfunction can arise in head and neck cancer patients receiving external‑beam radiation and adjuvant chemotherapy, especially when the larynx or tongue base are irradiated, potentially compromising oral and pharyngeal motility. Videofluorographic swallowing studies were performed on all nine patients, with analyses of motility disorders, residue, aspiration, timing, and biomechanical efficiency, including calculation of oropharyngeal swallow efficiency for the first swallow of each bolus. The study found that most patients exhibited oral and pharyngeal motility disorders, with seven of nine showing reduced posterior tongue base movement and laryngeal elevation, and that their oropharyngeal swallow efficiency, timing, distance, and coordination were significantly impaired compared to age‑matched normal subjects.

Abstract

Abstract The nature of swallowing problems was examined in nine patients treated primarily with external‐beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent videofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorders, residue, and aspiration; temporal analyses; and biomechanical analyses. Oropharyngeal swallow efficiency was calculated for the first swallow of each bolus. Swallow motility disorders were observed in both the oral and pharyngeal stages. Seven of the nine patients demonstrated reduced posterior tongue base movement toward the posterior pharyngeal wall and reduced laryngeal elevation during the swallow. Oropharyngeal swallow efficiency measures were significantly lower in the nine irradiated patients than in age‐matched normal subjects. Between patients and normal subjects, significant differences were found in the measures of timing and distance of pharyngeal structural movements during the swallow, as well as in the measures of coordination during the swallow. Although treatment of head and neck cancer with external‐beam radiation is designed to provide cancer cure and preserve organ functioning, oral and pharyngeal motility for swallow can become compromised if external‐beam radiation treatment is provided to either the larynx or tongue base regions.