Hutcheson Katherine A, Barringer Denise A, Rosenthal David I, May Annette H, Roberts Dianna B, Lewin Jan S
Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Arch Otolaryngol Head Neck Surg. 2008 Feb;134(2):178-83. doi: 10.1001/archoto.2007.33.
To describe swallowing physiology and functional outcomes at select intervals after definitive radiotherapy for laryngeal carcinoma. We also examined associations among patient, tumor, and treatment characteristics and swallowing outcomes.
Retrospective review.
The University of Texas M. D. Anderson Cancer Center, Houston.
This study cohort included 40 patients who underwent definitive radiotherapy for laryngeal carcinoma (from February 2001 to June 2004).
Modified barium swallow (MBS) studies were performed for 32 patients at 3 test intervals following irradiation: less than 6 months, 6 to 11 months, and 12 or more months. We recorded the presence or absence of aspiration (sensate or silent), 5 pharyngeal phase disorders, and 2 structural abnormalities. We also recorded pretreatment dysphagia complaints, feeding tube dependency, T classification, disease site, mucositis grade, and radiotherapy schedule with or without chemotherapy.
Eighty-four percent of patients (27 of 32) referred for MBS studies after undergoing radiotherapy aspirated; 44% (12 of 27) did so silently. Silent aspiration was more prevalent during MBS studies conducted 1 or more years after radiotherapy. Pharyngeal phase disorders were observed more frequently than structural abnormalities (P < .01). Most patients required a feeding tube (78% [31 of 40]); however, 52% of the tubes (16) were eventually removed. We found no significant association between the occurrence of aspiration and disease site, T classification, treatment regimen, or pretreatment variables (P > .05). Pretreatment and posttreatment levels of feeding tube dependency were significantly associated (P = .03). Patient-reported dysphagia before treatment did not predict posttreatment swallowing outcomes (P > .05).
Dysphagia is a common outcome after laryngeal preservation with radiotherapy. Contrary to expectations, few parameters that we measured were significantly associated with swallowing outcomes in our study.
描述喉癌根治性放疗后特定时间间隔的吞咽生理及功能结果。我们还研究了患者、肿瘤及治疗特征与吞咽结果之间的关联。
回顾性研究。
休斯敦的德克萨斯大学MD安德森癌症中心。
本研究队列包括40例接受喉癌根治性放疗的患者（2001年2月至2004年6月）。
对32例患者在放疗后的3个测试时间间隔进行改良钡餐吞咽（MBS）研究：少于6个月、6至11个月、12个月及以上。我们记录有无误吸（有感觉的或无声的）、5种咽期障碍及2种结构异常。我们还记录了治疗前吞咽困难主诉、依赖饲管情况、T分级、病变部位、黏膜炎分级以及有无化疗的放疗方案。
放疗后接受MBS研究的患者中84%（32例中的27例）存在误吸；44%（27例中的12例）为无声误吸。无声误吸在放疗1年或更久后进行的MBS研究中更常见。咽期障碍比结构异常更常被观察到（P <.01）。大多数患者需要饲管（78%[40例中的31例]）；然而，最终52%的饲管（16根）被拔除。我们发现误吸的发生与病变部位、T分级、治疗方案或治疗前变量之间无显著关联（P >.05）。治疗前和治疗后饲管依赖水平显著相关（P =.03）。患者报告的治疗前吞咽困难不能预测治疗后的吞咽结果（P >.05）。
放疗保留喉功能后吞咽困难是常见结果。与预期相反，我们研究中测量的参数很少与吞咽结果显著相关。
