Mechanisms of Impaired Swallowing on Thin Liquids Following Radiation Treatment for Oropharyngeal Cancer.

Carly E A Barbon,Douglas B Chepeha,Catriona M Steele,Melanie Peladeau-Pigeon,Andrew J Hope,Ashley A Waito

doi:10.1044/2020_jslhr-19-00220

Abstract

PurposeDysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer. Despite the high prevalence of dysphagia in patients with head and neck cancer, we lack understanding of the specific changes in swallowing physiology that arise in the short-term following radiation therapy and how these changes impact the key functions of swallowing safety and efficiency. This study sought to identify pathophysiological mechanisms underlying impairments in swallowing safety and efficiency on thin liquids following (chemo)radiation for oropharyngeal cancer.MethodVideofluoroscopic swallowing studies were completed in 12 male patients within 6 months following completion of (chemo)radiation and in 12 healthy male controls. To compare swallowing function and physiology between groups, we analyzed three discrete sips of 20% w/v thin liquid barium per participant. The videofluoroscopic swallowing study recordings were rated for swallowing safety, efficiency, timing parameters, and pixel-based measures of structural area or movement.ResultsThe oropharyngeal cancer cohort displayed significantly higher frequencies of penetration–aspiration, incomplete laryngeal vestibule closure, prolonged time-to-laryngeal vestibule closure, and poor pharyngeal constriction. Incomplete or delayed laryngeal vestibule closure was associated with airway invasion, while poor pharyngeal constriction was associated with pharyngeal residue.ConclusionsThis study highlights the primary mechanisms behind impaired safety and efficiency of the swallow in patients following (chemo)radiation for oropharyngeal cancer.

Highlights

Dysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer
Pharyngeal residue is a common finding in individuals with dysphagia, and previous studies have implicated reduced pharyngeal constriction as a primary mechanism associated with pharyngeal residue (Dejaeger et al, 1997; Kahrilas et al, 1992; Langmore & Krisciunas, 2010; Stokely et al, 2015; Ursino et al, 2016; Waito, Tabor-Gray et al, 2018)
We identified various mechanisms that contribute to impaired swallowing safety and efficiency on thin liquid swallows in a group of 12 oropharyngeal cancer patients, compared to 12 healthy controls

Summary

Introduction

Dysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer. Despite the high prevalence of dysphagia in patients with head and neck cancer, we lack understanding of the specific changes in swallowing physiology that arise in the short-term following radiation therapy and how these changes impact the key functions of swallowing safety and efficiency. Conclusions: This study highlights the primary mechanisms behind impaired safety and efficiency of the swallow in patients following (chemo)radiation for oropharyngeal cancer. Radiation-induced stenosis of the UES has been reported as a negative sequela of (chemo)radiation and may be associated with pharyngeal residue (Eisbruch et al, 2002; Farwell et al, 2010; Kotz et al, 2004; Pauloski et al, 1998) The impact of these pharyngeal and UESbased changes on pharyngeal constriction and bolus clearance remains unclear

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