Early Swallowing Problems in a Cohort of Patients With Nasopharyngeal Carcinoma: Symptomatology and Videofluoroscopic Findings

Abstract

To study the incidence and the degree of swallowing dysfunction in patients with nasopharyngeal carcinoma (NPC) who underwent radiation therapy treatment. The study was conducted in the Prince of Wales Hospital, a tertiary teaching hospital of the Chinese University of Hong Kong. From October 1999 to July 2001, a cohort of 20 consecutive patients with newly diagnosed NPC was prospectively studied. Questions about symptoms, including swallowing functions, were asked, and head and neck examination including oromotor examination was performed in the subjects before radiation therapy. All patients were subjected to videofluoroscopy (VFSS) to assess their swallowing function. Abnormalities were scored if they were present on two of three swallow attempts. The patients were reassessed at 6 months and 12 months after radiotherapy by symptom assessment and VFSS. There were 14 male and 6 female patients. The mean age was 43.9 years. Nine patients had early (stage I and II) disease, whereas 11 patients had advanced (stage III and IV) disease. Nine patients were treated by radiation therapy only and 11 patients by concurrent chemoirradiation. Ninety-five percent of the subjects had subjective dysphagia at 6 and 12 months after radiation therapy. Ninety percent had xerostomia, and 80% had to avoid certain foods at 12 months postradiation therapy. All subjects had to alternate solid food with fluid intake to facilitate swallowing. An average reduction of jaw movement by 1 cm was noted. A large proportion of patients had stasis of food in the pharynx (100% in valleculae and 60% in pyriform fossae) and impaired pharyngeal peristalsis (60%). One quarter of patients had laryngeal penetration. Subjective swallowing difficulties were common in patients in the early follow-up period after radiation therapy for NPC according to questionnaire assessment. An objective swallowing study revealed that swallowing dysfunction was persistent 12 months after radiation therapy.