Prevalence and Associated Impacts of Cervical Esophageal Clearance Issues Post Chemoradiotherapy for Nasopharyngeal Carcinoma (NPC)
- 29 Downloads
At present, the nature and extent of upper esophageal stage clearance issues following nonsurgical management of nasopharyngeal cancer (NPC) is not well elucidated. The aim of this study was to conduct an initial retrospective study of the prevalence and severity of upper esophageal clearance impairments in a cohort of patients post-NPC management. A secondary aim was to explore any observed relationship between severity of impairment with both (a) aspiration and (b) temporal oropharyngeal swallowing measures. A cohort of 134 NPC patients who received curative intent (chemo)radiotherapy (C/RT) and completed a videofluoroscopic swallowing study (VFSS) between 2012 and 2015 were reviewed. An Esophageal Clearance parameter, based on the scale used in MBSImP was used to classify the presence and severity of esophageal impairment on thin liquid and semisolids. Data on oral and pharyngeal temporal measures, pharyngeal constriction, and penetration/aspiration were also collected. The prevalence of cervical esophageal clearance impairment was high with ratings > 0 observed among 83% and 97% of patients on thin liquid and semisolids, respectively. With the increasing impairment, significantly (p < 0.05) increased oral transit times were observed for liquid swallows, and increased pharyngeal transit times for semisolids. Significantly higher proportions of patients presented with penetration/aspiration in the group with more severe esophageal clearance impairment. Results confirm that cervical esophageal clearance impairment is highly prevalent post-C/RT treatment for NPC. Causality cannot be determined from this study; however, this initial evidence supports that esophageal impairment may coexist in patients post NPC, presenting with more severe oral/pharyngeal deficits, and the impact of this on swallow function needs to be considered. Further systematic research is required.
KeywordsDysphagia Nasopharyngeal carcinoma Cervical esophagus Stricture Stenosis Dysmotility
The authors wish to thank Dr. Laurelie Wall and Kelvin Tsai for their contribution in the interrater reliability data and also the speech therapists from Queen Mary Hospital who performed the VFSS from 2012 to 2015.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Brady LW, Heilmann HP, Molls M, Nieder C, Harari PM, Connor NP. Functional preservation and quality of life in head and neck radiotherapy function preservation and quality of life in head and neck radiotherapy. Dordrecht: Springer; 2009.Google Scholar
- 2.GLOBOCAN. http://globocan.iarc.fr/Default.aspx. 2018. Accessed 1 Sept 2018.
- 3.Authority TH. Cancerfacts. http://www3.ha.org.hk/cancereg/Statistics.html. 2018. Accessed 1 Sept 2018.
- 6.Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16(4):1310–7.CrossRefGoogle Scholar
- 8.Wolff HA, Rodel RM, Gunawan B, Overbeck T, Herrmann MK, Hennies S, Hille A, Vorwerk H, Matthias C, Hess CF, Christiansen H. Nasopharyngeal carcinoma in adults: treatment results after long-term follow-up with special reference to adjuvant interferon-beta in undifferentiated carcinomas. J Cancer Res Clin Oncol. 2010;136(1):89–97. https://doi.org/10.1007/s00432-009-0640-2.CrossRefGoogle Scholar
- 9.Lee AW, Ng WT, Hung WM, Choi CW, Tung R, Ling YH, Cheng PT, Yau TK, Chang AT, Leung SK, Lee MC, Bentzen SM. Major late toxicities after conformal radiotherapy for nasopharyngeal carcinoma-patient- and treatment-related risk factors. Int J Radiat Oncol Biol Phys. 2009;73(4):1121–8. https://doi.org/10.1016/j.ijrobp.2008.05.023.CrossRefGoogle Scholar
- 12.Ku PK, Yuen EH, Cheung DM, Chan BY, Ahuja A, Leung SF, Tong MC, van Hasselt A. Early swallowing problems in a cohort of patients with nasopharyngeal carcinoma: symptomatology and videofluoroscopic findings. Laryngoscope. 2007;117(1):142–6. https://doi.org/10.1097/01.mlg.0000248738.55387.44.CrossRefGoogle Scholar
- 27.Kotz T, Federman AD, Kao J, Milman L, Packer S, Lopez-Prieto C, Forsythe K, Genden EM. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg. 2012;138(4):376–82. https://doi.org/10.1001/archoto.2012.187.CrossRefGoogle Scholar
- 28.Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, Duivestein J, Kayashita J, Lecko C, Murray J, Pillay M, Riquelme L, Stanschus S. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293–314. https://doi.org/10.1007/s00455-016-9758-y.CrossRefGoogle Scholar
- 31.Logemann JA. Evaluation and treatment of swallowing disorders. 2nd ed. Austin, TX: PRO-ED; 1998.Google Scholar
- 38.Kaye SA, Siraj QH, Agnew J, Hilson A, Black CM. Detection of early asymptomatic esophageal dysfunction in systemic sclerosis using a new scintigraphic grading method. J Rheumatol. 1996;23(2):297–301.Google Scholar
- 40.Wolf DC. Dysphagia. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. Boston; 1990.Google Scholar
- 41.Gullung JL, Hill EG, Castell DO, Martin-Harris B. Oropharyngeal and esophageal swallowing impairments: their association and the predictive value of the modified barium swallow impairment profile and combined multichannel intraluminal impedance-esophageal manometry. Ann Otol Rhinol Laryngol. 2012;121(11):738–45.CrossRefGoogle Scholar