Dysphagia after Sequential Chemoradiation Therapy for Advanced Head and Neck Cancer

Department of Surgery/Division of Otolaryngology, at the Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston, MA 02115, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 07/2006; 134(6):916-22. DOI: 10.1016/j.otohns.2006.02.001
Source: PubMed


Assess impact of sequential chemoradiation therapy (SCRT) for advanced head and neck cancer (HNCA) on swallowing, nutrition, and quality of life.
Prospective cohort study of 59 patients undergoing SCRT for advanced head and neck cancer. Follow-up median was 47.5 months.
Regional Cancer Center.
Median time to gastrostomy tube removal was 21 weeks. Eighteen of 23 patients who underwent modified barium swallow demonstrated aspiration; none developed pneumonia. Six of 7 with pharyngoesophageal stricture underwent successful dilatation. Functional Assessment of Cancer Therapy-Head and Neck Scale questionnaires at median 6 months after treatment revealed "somewhat" satisfaction with swallowing. At the time of analysis, 97% have the gastronomy tube removed and take soft/regular diet.
Early after treatment dysphagia adversely affected weight, modified barium swallow results, and quality of life. Diligent swallow therapy, and dilation as needed, allowed nearly all patients to have their gastronomy tubes removed and return to a soft/regular diet.
Dysphagia is significant after SCRT but generally slowly recovers 6 to 12 months after SCRT.

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Available from: Donald J Annino, Dec 19, 2014
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    • "However, under half were on modified texture diets at PEG removal, confirming that a degree of altered swallowing ability persisted in this group of high risk patients. Of these though, only 21% were on extremely modified (puree or liquid puree) diets, consistent with prior research which reports that most patients provided with a PEG are tolerating a normal or semi-solid diet at 1 year post treatment [8] [10] [23]. It is recognized that the lack of quality of life data is a limitation of this study. "
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    Full-text · Article · Apr 2015
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    • "In the literature only a few studies combine VMBS examinations with QOL questionnaires [6-8,11]. These studies also show some limitations; i.e. the VMBS was only performed after CRT and based on patient or clinician appreciated swallowing difficulties beyond that expected after treatment [7]; the authors did not use a QOL questionnaire to analyze the patients' perceived problems, but only one single question [8] or a 7-point scale [11]; or the authors did not correlate the VMBS examinations to the QOL outcomes [6]. "
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