Jensen Kenneth, Lambertsen Karin, Grau Cai
Department of Oncology, Aarhus University Hospital, Denmark.
Radiother Oncol. 2007 Oct;85(1):74-82. doi: 10.1016/j.radonc.2007.06.004. Epub 2007 Jul 27.
Dysphagia and swallowing problems are common in pharynx cancer patients treated with radiotherapy. Dysfunction of the upper aerodigestive tract may lead to reduced quality of life, malnutrition and aspiration pneumonia. The aim of the current study was to describe swallowing function after radiotherapy and examine its correlation with irradiated volume and dose.
All recurrence free patients treated for pharynx cancer with radical radiotherapy at our institution, between 1998 and 2002, were invited to participate, 35 (55% of eligible) agreed. Patients were examined with EORTC quality of life questionnaires and functional endoscopic evaluation of swallowing. Organs at risk were delineated on planning CT scans, available for 25 patients.
Eighty-three percent of patients had some degree of dysphagia. Reduced sensitivity was observed in 94%, residues in 88%, penetration in 59% and aspiration in 18% of patients. Several significant correlations were found between both subjective and objective swallowing problems and DVH parameters of the upper aerodigestive tract. Doses less than 60 Gy to the supraglottic region, the larynx and upper esophageal sphincter resulted in a low risk of aspiration.
Both subjective and objective swallowing problems were frequent and severe after radiotherapy for pharynx cancer. Swallowing dysfunction was correlated with dose and volume parameters of the upper aerodigestive tract.
吞咽困难和吞咽问题在接受放射治疗的咽喉癌患者中很常见。上呼吸道消化道功能障碍可能导致生活质量下降、营养不良和吸入性肺炎。本研究的目的是描述放射治疗后的吞咽功能，并检查其与照射体积和剂量的相关性。
邀请了1998年至2002年间在我们机构接受根治性放射治疗的所有无复发咽喉癌患者参与研究，35名患者（占符合条件者的55%）同意参加。使用欧洲癌症研究与治疗组织生活质量问卷和吞咽功能内镜评估对患者进行检查。在计划CT扫描上勾勒出危及器官，25名患者有该扫描资料。
83%的患者有一定程度的吞咽困难。94%的患者存在感觉减退，88%的患者有残留物，59%的患者有穿透现象，18%的患者有误吸。在上呼吸道消化道主观和客观吞咽问题与剂量体积直方图参数之间发现了几个显著的相关性。声门上区、喉部和食管上括约肌接受小于60 Gy的剂量会导致误吸风险较低。
咽喉癌放射治疗后，主观和客观吞咽问题都很常见且严重。吞咽功能障碍与上呼吸道消化道的剂量和体积参数相关。
