Murphy Barbara A, Gilbert Jill
Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, TN 37232-6307, USA.
Semin Radiat Oncol. 2009 Jan;19(1):35-42. doi: 10.1016/j.semradonc.2008.09.007.
Dysphagia is commonly seen in patients undergoing radiation-based therapy for locally advanced squamous carcinoma of the head and neck. Within 4 to 5 weeks of starting therapy, patients develop mucositis, radiation dermatitis, and edema of the soft tissues. Resulting pain, copious mucous production, xerostomia, and tissue swelling contribute to acute dysphagia. As the acute effects resolve, late effects including fibrosis, lymphedema, and damage to neural structures become manifest. Both acute and late effects result in adverse sequelae including aspiration, feeding tube dependence, and nutritional deficiencies. Early referral for evaluation by speech-language pathologists is critical to (1) ensure adequate assessment of swallow function, (2) determine whether further testing is needed to diagnose or treat the swallowing disorder, (3) generate a treatment plan that includes patient education and swallow therapy, (4) work with dieticians to ensure adequate and safe nutrition, and (5) identify patients with clinically significant aspiration.
吞咽困难在接受头颈部局部晚期鳞状细胞癌放射治疗的患者中很常见。在开始治疗后的4至5周内，患者会出现粘膜炎、放射性皮炎和软组织水肿。由此产生的疼痛、大量粘液分泌、口干和组织肿胀导致急性吞咽困难。随着急性效应的消退，包括纤维化、淋巴水肿和神经结构损伤在内的晚期效应开始显现。急性和晚期效应都会导致不良后果，包括误吸、依赖饲管和营养缺乏。早期转介给言语病理学家进行评估至关重要，以便(1)确保对吞咽功能进行充分评估，(2)确定是否需要进一步检查以诊断或治疗吞咽障碍，(3)制定包括患者教育和吞咽治疗的治疗计划，(4)与营养师合作以确保充足和安全的营养，以及(5)识别具有临床显著误吸的患者。
