Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of amono-institutional prospective study.

Abstract

Aprospective instrumental assessment of late dysphagia using swallowing organs at risk (SWOARs)-sparing IMRT for nasopharyngeal and oropharyngeal cancers. Objective instrumental assessment included fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFS) at baseline, and at 6 and 12months after treatment. FEES assessed the pharyngeal residue according to the Farneti pooling score (P-score) as follows: 4-5 no dysphagia; 6-7 mild dysphagia; 8-9moderate dysphagia; 10-11severe dysphagia. Three different consistencies were tested for the P‑score: liquid (L), semisolid (SS), and solid (S). VFS assessed penetration-aspiration according to the Penetration-Aspiration Scale (PAS) and two different consistencies of the bolus were tested: thin liquid barium (L) and paste barium (S). 38patients were evaluable. There was asignificant worsening of the P‑score at 6months both for SS (p = 0.015) and S (p < 0.001), which persisted only for S at 12months (p < 0.0001). Similarly, there was asignificant worsening of the PAS score at 6 and 12months (p = 0.065 and 0.039, respectively) for the Sbolus. Overall, 3-7 and 10-14% aspiration after L and S was observed, respectively. Promising results using aSWOARs-sparing IMRT technique are reported. Therefore, treatment plans should be optimized for reducing doses to these structures.