Lindblom Ulrika, Nilsson Per, Gärskog Ola, Kjellen Elisabeth, Laurell Göran, Wahlberg Peter, Zackrisson Björn, Levring Jäghagen Eva
a Department of Clinical Sciences, Oncology and Radiation Physics , Lund University , Sweden ;
b Department of Otorhinolaryngology , Kirkenes Hospital , Norway ;
Acta Otolaryngol. 2016;136(3):304-11. doi: 10.3109/00016489.2015.1113439. Epub 2016 Jan 12.
Conclusion Neck dissection after radiotherapy increased the risk of aspiration as a late effect in a sub-sample of patients treated for head and neck cancer in the ARTSCAN study. Patients treated with accelerated fractionation (AF) developed aspiration, with or without coughing, more frequently than patients treated with conventional fractionation (CF). Objectives A long-term follow-up study was conducted to determine the frequency of aspiration as a late effect in patients with head and neck cancer treated with AF or CF. Method One-hundred and eight patients were recruited from two centres of the Swedish multi-centre study, ARTSCAN, where AF and CF were compared. Patients with positive lymph nodes were treated with neck dissection after completing radiotherapy. The follow-up was performed at a median of 65 months after initiation of radiotherapy and included an ENT and a videofluoroscopic examination. Results Aspiration was found in 51/108 (47%) and silent aspiration in 34/96 (35%) patients. Neck dissection (n = 47 patients) was significantly associated with both aspiration and silent aspiration. Aspiration was more common among patients treated with AF (34/61; 56%) compared to CF (17/47; 36%; p = 0.053). Silent aspiration was also more common after AF (24/54; 44%) than after CF (10/42; 24%; p = 0.052).
结论 在ARTSCAN研究中，接受放疗后的颈部清扫术增加了头颈部癌患者亚组中吞咽困难这一迟发效应的风险。与接受常规分割放疗（CF）的患者相比，接受加速分割放疗（AF）的患者出现吞咽困难（无论有无咳嗽）的频率更高。目的 开展一项长期随访研究，以确定接受AF或CF治疗的头颈部癌患者中吞咽困难迟发效应的发生频率。方法 从瑞典多中心研究ARTSCAN的两个中心招募了108例患者，该研究对AF和CF进行了比较。淋巴结阳性的患者在完成放疗后接受颈部清扫术。随访在放疗开始后的中位时间65个月进行，包括耳鼻喉科检查和视频透视检查。结果 在108例患者中有51例（47%）出现吞咽困难，在96例患者中有34例（35%）出现隐性吞咽困难。颈部清扫术（47例患者）与吞咽困难和隐性吞咽困难均显著相关。与CF组（17/47；36%；p=0.053）相比，AF组患者中吞咽困难更为常见（34/61；56%）。AF组后隐性吞咽困难也比CF组更常见（24/54；44%比10/42；24%；p=0.052）。
