Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, 400012, India.
Dysphagia. 2011 Dec;26(4):399-406. doi: 10.1007/s00455-011-9326-4. Epub 2011 Feb 23.
The aim of this study was to objectively assess swallowing function and factors impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated with definitive CRT. Objective assessment of swallowing function was done using modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups. Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal swallowing was defined in terms of incidence and severity of penetration-aspiration, pharyngeal residue, postural change, and regurgitation. Aspiration, residual, postural change, and regurgitation were present on baseline pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively, at 6-month post-CRT evaluation. The proportion of patients with high PAS scores (3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among patients (n = 34) with low PAS scores (≤2) at baseline, additional impairment of swallowing function was seen in 53 and 46% at 2- and 6-month assessment, respectively. Residue (44%) and aspiration (18%) domains were impaired in a higher proportion of patients after CRT. Thin and thick barium had higher aspiration and residue function impairment, respectively. Patients with pre-CRT poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P = 0.05), and large tumor volume (P = 0.05) had significantly worse objective swallowing function at baseline as demonstrated by pretreatment PAS scores. This study provides useful information regarding patterns of objective swallowing dysfunction in patients treated with definitive (chemo)radiotherapy. There is significant impairment of objective swallowing function in all domains following CRT, with residue and aspiration domains being affected most significantly.
本研究旨在客观评估头颈部鳞状细胞癌（HNSCC）根治性（放化疗）后吞咽功能及其影响因素。对 47 例局部晚期（T1-4、N0-3）HNSCC 患者进行根治性 CRT 治疗，对其吞咽功能进行了研究。在基线（放化疗前）和随后的随访中，使用改良钡吞咽（MBS）对吞咽功能进行客观评估。MBS 评分采用渗透-吸入评分（PAS）。异常吞咽定义为渗透-吸入、咽部残留、体位改变和反流的发生率和严重程度。9 例（19%）、11 例（23%）、10 例（21%）和 5 例（10%）患者在基线放化疗前评估中存在吸入、残留、体位改变和反流，分别增加至 11 例（29%）、11 例（29%）、12 例（32%）和 10 例（26%）患者在放化疗后 6 个月评估时。基线时 PAS 评分（3-7）为 27%的患者比例增加至放化疗后 6 个月时的 37%。在基线时 PAS 评分（≤2）较低的 34 例患者中，分别有 53%和 46%在 2 个月和 6 个月评估时出现吞咽功能进一步受损。在 CRT 后，更多的患者出现残留（44%）和吸入（18%）功能障碍。稀薄和浓稠的钡剂分别导致更高比例的患者出现吸入和残留功能障碍。放化疗前主观吞咽功能较差的患者（P=0.004）、下咽原发肿瘤（P=0.05）和大肿瘤体积（P=0.05）的患者，其基线时的预处理 PAS 评分显示其客观吞咽功能明显较差。本研究提供了有关根治性（放化疗）治疗后患者客观吞咽功能障碍模式的有用信息。在 CRT 后，所有领域的客观吞咽功能均有明显受损，残留和吸入领域受影响最明显。
