Management of Dysphagia Following Radiotherapy

  • Shashikant Vishnubhai Limbachiya
  • R. Anoop
  • Krishnakumar Thankappan


Severe persistent dysphagia is now recognized as a common complication among the patients who underwent radiotherapy (RT) or chemoradiotherapy (CRT) both in immediate and long-term posttreatment period [1]. Table 28.1 shows the potential complications of RT that can contribute to dysphagia. This chapter will give an overview of the management of dysphagia related to RT or CRT in the management of head and neck cancers.


Radiation (RT) Persistent Severe Dysphagia Neuromuscular Electrical Stimulation (NMES) Amifostine Intensity-modulated Radiotherapy (IMRT) 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 28.1

FEES Case 1 (MP4 110300 kb)

Video 28.2

VFS Case 1 (MP4 139241 kb)

Video 28.3

FEES Case 2 (MP4 170032 kb)

Video 28.4

VFS Case 2 (MP4 49364 kb)

Video 28.5

FEES Case 3 (MP4 225855 kb)

Video 28.6

VFS Case 3 (MP4 99778 kb)

Video 28.7

Scopy Case 4 (MP4 158787 kb)

Video 28.8

FEES Case 4 (MP4 203965 kb)

Video 28.9

VFS Case 4 (MP4 72174 kb)

Video 28.10

Scopy Case 5 (MP4 167767 kb)

Video 28.11

VFS Case 5 (MP4 53685 kb)


  1. 1.
    Nutting CM, Morden JP, Harrington KJ, PARSPORT trial management group, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.CrossRefGoogle Scholar
  2. 2.
    Kirby DF, DeLegge MH, Fleming CR, American Gastroenterological Association. American Gastroenterological Association medical position statement: guidelines for the use of enteral nutrition. Gastroenterology. 1995;108:1280–301.CrossRefGoogle Scholar
  3. 3.
    Corry J, Poon W, McPhee N, et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo) radiation. Head Neck. 2009;31:867–76.CrossRefGoogle Scholar
  4. 4.
    Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A. Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys. 2010;76:S58–63.CrossRefGoogle Scholar
  5. 5.
    Braam PM, Roesink JM, Moerland MA, Raaijmakers CP, Schipper M, Terhaard CH. Long-term parotid gland function after radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62:659–64.CrossRefGoogle Scholar
  6. 6.
    Brizel DM, Wasserman TH, Henke M, et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol. 2000;18:3339–45.CrossRefGoogle Scholar
  7. 7.
    Wasserman TH, Brizel DM, Henke M, et al. Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and- neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys. 2005;63:985–90.CrossRefGoogle Scholar
  8. 8.
    Buentzel J, Micke O, Adamietz IA, Monnier A, Glatzel M, de Vries A. Intravenous amifostine during chemoradiotherapy for head-and-neck cancer: a randomized placebo-controlled phase III study. Int J Radiat Oncol Biol Phys. 2006;64:684–91.CrossRefGoogle Scholar
  9. 9.
    Liu XK, Su Y, Jha N, et al. Submandibular salivary gland transfer for the prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma: 5-year outcomes. Head Neck. 2011;33:389–95.PubMedGoogle Scholar
  10. 10.
    Jha N, Seikaly H, Harris J, et al. Phase III randomized study: oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia. Head Neck. 2009;31:234–43.CrossRefGoogle Scholar
  11. 11.
    Jensen SB, Pedersen AM, Vissink A, Salivary Gland Hypofunction/Xerostomia Section; Oral Care Study Group; Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO), et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. 2010;18:1061–79.CrossRefGoogle Scholar
  12. 12.
    Chambers MS, Posner M, Jones CU, et al. Cevimeline for the treatment of postirradiation xerostomia in patients with head and neck cancer. Int J Radiat Oncol Biol Phys. 2007;68:1102–9.CrossRefGoogle Scholar
  13. 13.
    Meng Z, Kay Garcia M, Hu C, et al. Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer. 2012;48:1692–9.CrossRefGoogle Scholar
  14. 14.
    Hanchanale S, Adkinson L, Daniel S, Fleming M, Oxberry SG. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer. 2015;23:881–8.CrossRefGoogle Scholar
  15. 15.
    Forner L, Hyldegaard O, von Brockdorff AS, et al. Does hyperbaric oxygen treatment have the potential to increase salivary flow rate and reduce xerostomia in previously irradiated head and neck cancer patients? A pilot study. Oral Oncol. 2011;47:546–51.CrossRefGoogle Scholar
  16. 16.
    Bressan V, Bagnasco A, Aleo G, et al. The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer. 2017;25:1699–712.CrossRefGoogle Scholar
  17. 17.
    Arrese LC, Lazarus CL. Special groups: head and neck cancer. Otolaryngol Clin N Am. 2013;46:1123–36.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Shashikant Vishnubhai Limbachiya
    • 1
  • R. Anoop
    • 2
  • Krishnakumar Thankappan
    • 1
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia
  2. 2.Department of Radiation OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

Personalised recommendations