Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma

  • Honghong Li
  • Liting Li
  • Xiaolong Huang
  • Yi Li
  • Tangjie Zou
  • Xiaohuang Zhuo
  • Yan Chen
  • Yimin LiuEmail author
  • Yamei TangEmail author
Original Article



To investigate the swallowing status and its impact on quality of life (QOL) in patients who underwent radiotherapy for nasopharyngeal carcinoma (NPC).


In this study, 334 patients with NPC who underwent radiotherapy were reviewed. Clinical characteristics, videofluoroscopic swallowing studies (VFSSs), and scores of the World Health Organization quality of life-BREF (WHOQOL-BREF) were retrospectively analyzed for all patients.


In this study, 143 of 334 (42.8%) patients showed dysphagia. The nodular stage N3 of NPC, neoadjuvant and concurrent chemotherapy were clinical predictors for dysphagia. VFSS of patients with dysphagia showed a high incidence of vallecular residue (100%), apraxia (99%), premature bolus loss (98%), bolus formation (98%), pyriform sinus residue (95%), and mastication (94%). Moreover, WHOQOL-BREF scores for the physical health, psychological, and environment domains were lower of the dysphagia group than those of the control group (P < 0.01). Videofluoroscopic dysphagia scale scores showed significant negative correlations with scores for the physical health (R = −0.66, P < 0.01), psychological (R = −0.70, P < 0.01), social relationships (R = −0.56, P < 0.01), and environment (R = −0.61, P < 0.01) domains of WHOQOL-BREF.


Radiotherapy-induced dysphagia is common in NPC patients and is correlated with poor quality of life. Patients, caregivers, and clinical physicians should be aware of these adverse effects and provide timely treatment for radiotherapy-induced dysphagia in collaboration with cross-disciplinary colleagues.


Radiotherapy Dysphagia NPC Videofluoroscopic swallowing study Quality of life 

Strahlentherapieinduzierte Dysphagie und ihr Einfluss auf die Lebensqualität von Menschen mit Nasopharynxkarzinom



Untersuchung der Schluckfunktion und ihre Auswirkungen auf die Lebensqualität (QOL) bei Patienten, die eine Strahlentherapie aufgrund eines Nasopharynxkarzinoms (NPC) erhalten haben.


In dieser Studie wurden 334 Patienten mit NPC, die eine Strahlentherapie erhielten, überprüft. Klinische Parameter, videofluoroskopische Schluckstudien (VFSS) und Ergebnisse aus dem World Health Organization Quality of Life Bref (WHOQOL-BREF), der die Lebensqualität von Patienten einschätzt, wurden retrospektiv für alle Patienten analysiert.


In dieser Studie zeigten 143 von 334 (42,8%) Patienten eine Dysphagie. Das noduläre Stadium N3 von NPC, neoadjuvante und gleichzeitige Chemotherapie waren klinische Prädiktoren für Dysphagie. Die VFSS von Patienten mit Dysphagie zeigten eine hohe Inzidenz von vallekulären Rückständen (100%), Apraxie (99%), vorzeitigem Bolusverlust (98%), Bolusbildung (98%), Resten des Sinus piriformis (95%) und Mastikation (94%). Darüber hinaus waren die Ergebnisse des WHOQOL-BREF für psychische Gesundheit, physische und Umwelt-Domäne bei der Dysphagie-Gruppe niedriger als bei der Kontrollgruppe (P < 0,01). Die videofluoroskopischen Dysphagie-Skalenwerte der WHOQOL-BREF für die Bereiche körperliche Gesundheit (R = −0,66; P < 0,01), psychologische (R = −0,70; P < 0,01) und soziale Beziehungen (R = −0,56; P < 0,01) und Umwelt (R = −0,61; P < 0,01) zeigten signifikante negative Korrelationen.


Strahlentherapieinduzierte Dysphagie ist bei NPC-Patienten häufig und korreliert mit schlechter Lebensqualität. Patienten, Pflegepersonal und klinische Ärzte sollten sich dieser Nebenwirkungen bewusst sein und eine zeitnahe Behandlung von strahlentherapieinduzierter Dysphagie in Zusammenarbeit mit interdisziplinären Kollegen anbieten.


Strahlentherapie Dysphagie NPC Videofluoroskopische Schluckstudie Lebensqualität 


Author Contributions

H. Li, L. Li and X. Huang, Yimin Liu and Yamei Tang contributed equally to the study. Honghong Li, data acquisition and evaluation, manuscript writing. Liting Li, data collection, analysis and interpretation. Xiaolong Huang, data analysis, drafting and manuscript revision. Yi Li, data collection and analysis. Tangjie Zou, data collection. Xiaohuang Zhuo, data interpretation, manuscript revision. Yan Chen, data collection. Yimin Liu, manuscript revision. Yamei Tang, study conception and design, manuscript revision, and approval of the version to be published.


This study was funded by National Natural Science Foundation of China (No. 81471249, 81622041), Major Program of Collaborative Innovation Specialized in Livehood Science Topics (201604020097), Science and Technology Planning Project of Guangdong Province (2016A050502016), and Tip-top Scientific and Technical Innovative Youth Talents of the Guangdong special support program (No. 2016TQ03R559) to Yamei Tang. Science and Technology Planning Project of Guangzhou (201704030033), and Young Teacher Training Program of Sun Yat-sen University (17ykpy38) to Yi Li.

Compliance with ethical guidelines

Conflict of interest

H. Li, L. Li, X. Huang, Y. Li, T. Zou, X. Zhuo, Y. Chen, Y. Liu and Y. Tang declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Honghong Li
    • 1
  • Liting Li
    • 2
  • Xiaolong Huang
    • 3
  • Yi Li
    • 1
  • Tangjie Zou
    • 1
  • Xiaohuang Zhuo
    • 1
  • Yan Chen
    • 1
  • Yimin Liu
    • 2
    Email author
  • Yamei Tang
    • 1
    • 4
    • 5
    Email author
  1. 1.Department of Neurology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhou, Guangdong ProvinceChina
  2. 2.Department of Radiation Oncology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina
  3. 3.Department of Intensive Care MedicineThe First Affiliated Hospital of Xiamen UniversityXiamen cityChina
  4. 4.Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouChina
  5. 5.Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of MedicineSun Yat-Sen UniversityGuangzhouChina

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