Starmer Heather M, Yang WuYang, Raval Raju, Gourin Christine G, Richardson Marian, Kumar Rachit, Jones Bronwyn, McNutt Todd, Cheng Zhi, Quon Harry
Johns Hopkins Outpatient Center, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 N. Caroline Street, Suite 6260, Baltimore, MD, 21287, USA,
Dysphagia. 2014 Jun;29(3):396-402. doi: 10.1007/s00455-014-9521-1. Epub 2014 Mar 15.
The aim of this study was to examine the impact of gabapentin (neurontin) on swallowing and feeding tube use during chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC), and physiologic swallowing outcomes following completion of treatment. A total of 23 patients treated for OPSCC with concurrent CRT and prophylactically treated for pain using gabapentin were assessed. Historical controls were matched for T stage and primary site of disease. Timing of PEG use and removal were recorded. Video fluoroscopic swallowing studies were completed post-treatment to assess physiologic outcomes as well as penetration-aspiration scores (PAS). Functional oral intake scale (FOIS) scores were determined at the time of swallowing evaluation to assess diet level. Patients treated with gabapentin began using their PEG tubes later (3.7 vs. 2.29 weeks; P = 0.013) and had their PEG tubes removed earlier (7.29 vs. 32.56 weeks; P = 0.039) than the historical controls. A number of physiologic parameters were found to be less impacted in the gabapentin group, including oral bolus control (P = 0.01), epiglottic tilt (P = 0.0007), laryngeal elevation (P = 0.0017), and pharyngeal constriction (P = 0.002). PAS scores were significantly lower in the group treated with gabapentin (1.89 vs. 4; P = 0.0052). Patients receiving gabapentin had more advanced diet levels at the time of the initial swallowing study as evidenced by their FOIS scores (5.4 vs. 3.21; P = 0.0003). We conclude that patients using gabapentin for pain management during CRT appears to do well maintaining swallow function during treatment and have favorable post-treatment physiologic swallowing outcomes. Prospective evaluation is warranted.
本研究的目的是探讨加巴喷丁（Neurontin）在口咽鳞状细胞癌（OPSCC）放化疗（CRT）期间对吞咽及饲管使用的影响，以及治疗结束后的吞咽生理结果。共评估了23例接受OPSCC同步CRT并预防性使用加巴喷丁治疗疼痛的患者。历史对照根据T分期和疾病原发部位进行匹配。记录PEG管使用和拔除的时间。治疗后完成视频荧光吞咽造影研究以评估生理结果及渗透-误吸评分（PAS）。在吞咽评估时确定功能性经口摄食量表（FOIS）评分以评估饮食水平。使用加巴喷丁治疗的患者开始使用PEG管的时间较晚（3.7周对2.29周；P = 0.013），且PEG管拔除时间较早（7.29周对32.56周；P = 0.039），均优于历史对照。发现加巴喷丁组的一些生理参数受影响较小，包括口腔食团控制（P = 0.01）、会厌倾斜（P = 0.0007）、喉提升（P = 0.0017）和咽缩窄（P = 0.002）。加巴喷丁治疗组的PAS评分显著更低（1.89对4；P = 0.0052）。接受加巴喷丁治疗的患者在初次吞咽研究时饮食水平更高，这从他们的FOIS评分中得到证明（5.4对3.21；P = 0.0003）。我们得出结论，在CRT期间使用加巴喷丁进行疼痛管理的患者在治疗期间似乎能很好地维持吞咽功能，且治疗后吞咽生理结果良好。有必要进行前瞻性评估。
