Objective dysphagia is very common after radiotherapy in oropharyngeal cancer patients.
Christina Pflug, Frank Müller, Jana-Christiane Koseki, Cordula Petersen, Julie Cläre Nienstedt, Silke Tribius
Author Information
Christina Pflug: Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: c.pflug@uke.de.
Frank Müller: Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Jana-Christiane Koseki: Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Cordula Petersen: Department of Radiotherapy and Radiation Oncology, Center for Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Julie Cläre Nienstedt: Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Silke Tribius: Department of Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany; Hermann-Holthusen Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany.
OBJECTIVE: Dysphagia is one of the most serious adverse events in the treatment of head and neck cancer. This cross-sectional study aimed to assess pharyngeal residue, and penetration/aspiration in oropharyngeal cancer patients (OPC) after radiotherapy using flexible endoscopic evaluation of swallowing (FEES). METHODS: A total of 35 OPC patients who had received radio-(chemo) therapy (R(C)T), including 8 patients with primary R(C)T), were included and examined by FEES to determine the swallowing status and were asked to indicate their swallowing ability on a visual scale to reflect the problem perceived by the patient. During FEES the patients were given three standardized bolus consistencies and four test pills. Penetration, aspiration, and residue were evaluated and classified. RESULT: Relevant dysphagia was present in 23/35 (66%) patients. Almost half of all patients (15/35) showed aspiration (53% (8/15) silent). Residue occurred in 91% but without correlation to aspiration. A significant association between dysphagia and impaired pill swallowing was found (P = .003) occurring in 20 of 35 patients. Even in patients with small tumors and without prior surgery severe dysphagia was found. CONCLUSIONS: Severe dysphagia is frequent after R(C)T affecting more than half of the patients with OPC. The frequent impaired pill swallowing ability should be considered Therefore, regular dysphagia diagnostics in the follow-up setting are advisable to initiate appropriate treatment and raise patients' quality of life, prevent aspiration pneumonia, and improve overall outcomes after tumor therapy.
