Radiation therapy with or without chemotherapy compromises swallowing efficiency and safety in patients with head and neck cancer (HNC). The resulting dysphagia leads to overall morbidity, with altered diets, reduced nutritional intake, reduced quality of life, and potential interruption of curative cancer treatment. Despite well-documented radiation-related changes in swallowing physiology, scarce research exists on the potential clinical value for measurements of swallowing timing and displacement in this population. This study investigated the discriminatory value of quantitative timing and displacement parameters for the Functional Oral Intake Scale and Penetration Aspiration Scale scores using pre- and post-radiation videofluoroscopy data. Swallowtail Software Version 1 (Belldev Medical, Arlington Heights, IL) was used to obtain objective timing and displacement measurements from the pre- and post-radiation videofluoroscopy data for 31 patients who underwent radiation therapy, with or without chemotherapy, for head and neck cancer. The total pharyngeal transit time (BP2) (p < 0.000, r = 0.43) in pudding bolus trials and the maximal upper esophageal sphincter opening (PESMax/cm) (p = 0.001, r = 0.31) in thin bolus trials were discriminatory for Functional Oral Intake Scale (FOIS). Findings suggest that measurement of post-radiation changes using objective and quantitative parameters may offer some discriminatory value regarding future dysphagia risk and prognosis based on total pharyngeal transit time and degree of UES opening. In addition, the results suggest that different bolus types may offer different discriminatory values in HNC population, and that some timing and displacement variables may have discriminatory value for patients’ diet levels independent from any aspiration risk.
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Kumar R, Madanikia S, Starmer H, Yang W, Murano E, Alcorn S, et al. Radiation dose to the floor of mouth muscles predicts swallowing complications following chemoradiation in oropharyngeal squamous cell carcinoma. Oral Oncol. 2014;50(1):65–70.
Lazarus CL, Husaini H, Hu K, Culliney B, Li Z, Urken M, et al. Functional outcomes and quality of life after chemoradiotherapy: baseline and 3 and 6 months post-treatment. Dysphagia. 2014;29(3):365–75.
Lenius K, Stierwalt J, LaPointe LL, Bourgeois M, Carnaby G, Crary M. Effects of lingual effort on swallow pressures following radiation treatment. JSLHR. 2015;58(3):687–97.
Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJM, et al. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85(1):64–73.
Nguyen NP, Moltz CC, Frank C, Karlsson U, Nguyen PD, Vos P, et al. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer. Eur J Radiol. 2006;59(3):453–9.
Russi EG, Corvò R, Merlotti A, Alterio D, Franco P, Pergolizzi S, et al. Swallowing dysfunction in head and neck cancer patients treated by radiotherapy: Review and recommendations of the supportive task group of the Italian Association of Radiation Oncology. Cancer Treat Rev. 2012;38(8):1033–49.
Starmer H, Quon H, Kumar R, Alcorn S, Murano E, Jones B, et al. The effect of radiation dose on swallowing: evaluation of aspiration and kinematics. Dysphagia. 2015;30(4):430–7.
Teguh DN, Levendag PC, Sewnaik A, Hakkesteegt MM, Noever I, Voet P, et al. Results of fiberoptic endoscopic evaluation of swallowing vs. radiation dose in the swallowing muscles after radiotherapy of cancer in the oropharynx. Radiother Oncol. 2008;89(1):57–63.
van der Molen L, Heemsbergen WD, de Jong R, van Rossum MA, Smeele LE, Rasch CRN, et al. Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures. Radiother Oncol. 2013;106(3):364–9.
Vlacich G, Spratt DE, Diaz R, Phillips JG, Crass J, Li C-I, et al. Dose to the inferior pharyngeal constrictor predicts prolonged gastrostomy tube dependence with concurrent intensity-modulated radiation therapy and chemotherapy for locally-advanced head and neck cancer. Radiother Oncol. 2014;110(3):435–40.
Wermker K, Jung S, Hüppmeier L, Joos U, Kleinheinz J. Prediction model for early percutaneous endoscopic gastrostomy (PEG) in head and neck cancer treatment. Oral Oncol. 2012;48(4):355–60.
Chadwick DD, Jolliffe J, Goldbart J, Burton MH. Barriers to caregiver compliance with eating and drinking recommendations for adults with intellectual disabilities and dysphagia. J Appl Res Intell Disabil. 2006;19(2):153–62.
Bruce SD. Radiation-induced xerostomia: how dry is your patient? [corrected] [published erratum appears in Clin J Oncol Nurs 2004 Apr; 8(2):116]. Clin J Oncol Nurs. 2004;8(1):61–7.
Wygoda A, Rutkowski T, Hutnik M, Skladowski K, Golen M, Pilecki B. Acute mucosal reactions in patients with head and neck cancer. Three patterns of mucositis observed during radiotherapy. Strahlenther Onkol. 2013;189(7):547–51.
Schindler A, Denaro N, Russi EG, Pizzorni N, Bossi P, Merlotti A, et al. Dysphagia in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus. Crit Rev Oncol Hematol. 2015;96(2):372–84.
Scherpenhuizen A, van Waes AMA, Janssen LM, Van Cann EM, Stegeman I. The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: a systematic review. Oral Oncol. 2015;51(8):745–50.
Virani A, Kunduk M, Fink DS, McWhorter AJ. Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck. 2015;37(2):162–70.
Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, et al. Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Int J Oral Maxillofac Surg. 2014;43(5):523–30.
Lazarus CL, Husaini H, Anand SM, Jacobson AS, Mojica JK, Buchbinder D, et al. Tongue strength as a predictor of functional outcomes and quality of life after tongue cancer surgery. Ann Otol Rhinol Laryngol. 2013;122(6):386–97.
Zhang L, Huang Z, Wu H, Chen W, Huang Z. Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. Eur J Oncol Nurs. 2014;18(6):626–9.
Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40.
Baijens L, Barikroo A, Pilz W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur J Radiol. 2013;82(10):1683–95.
Scott A, Perry A, Bench J. A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia. 1998;13(4):223–7.
Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, et al. MBS measurement tool for swallow impairment–MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.
Standardizing the MBS Study. n.d.; Available from: www.northernspeech.com/mbsimp/.
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.
Crary MA, Carnaby GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia. 2004;19(3):160–4.
Leonard RJ, Kendall KA, McKenzie S, Goncalves MI, Walker A. Structural displacements in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15(3):146–52.
Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60(5):1425–39.
Steele CM, Cichero JAY. Physiological factors related to aspiration risk: a systematic review. Dysphagia. 2014;29(3):295–304.
Kendall KA, McKenzie S, Leonard RJ, Gonçalves MI, Walker A. Timing of events in normal swallowing: a videofluoroscopic study. Dysphagia. 2000;15(2):74.
Hutcheson KA, Bhayani MK, Beadle BM, Gold KA, Shinn EH, Lai SY, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol-Head Neck Surg. 2013;139(11):1127–34.
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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.
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Vansant, M.B., Parker, L.A., McWhorter, A.J. et al. Predicting Swallowing Outcomes from Objective Videofluoroscopic Timing and Displacement Measures in Head and Neck Cancer Patients. Dysphagia (2020). https://doi.org/10.1007/s00455-020-10091-5
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