Department of Communication Sciences and Disorders, University of Wisconsin - Madison, 1975 Willow Drive, Madison, WI, 53706, USA.
Otolaryngology-Head & Neck Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
Dysphagia. 2021 Apr;36(2):242-249. doi: 10.1007/s00455-020-10128-9. Epub 2020 May 15.
Dysphagia associated with radiotherapy for head and neck cancer is complex and can be difficult to treat. Videofluoroscopic swallow studies (VFSS) are the current gold-standard instrumented swallow assessment. High-resolution manometry (HRM) is an additional approach that provides objective measurements of swallowing-related pressures in the pharynx and esophagus. This can provide functional information on the pressure gradients underlying bolus propulsion, and is relevant for this patient population, where radiation-related fibrosis can lead to weakness and impaired pressure generation. The purpose of this preliminary study was to describe pharyngeal swallowing pressures in patients with radiation-associated dysphagia (RAD) and late radiation-associated dysphagia (LRAD) using HRM. RAD occurs during and immediately following treatment, whereas LRAD is a more recently described phenomenon in which the patient experiences an onset of dysphagia at least 5 years post-treatment. We performed a retrospective analysis of pharyngeal swallowing pressures from 21 patients with RAD or LRAD and 21 healthy sex/age-matched controls. Patients with RAD or LRAD exhibited decreased swallowing pressure durations throughout the pharynx (p ≤ 0.002), as well as decreased hypopharynx maximum pressure (p = 0.003) and pharyngeal contractile integral ( p < 0.0001). Understanding how pharyngeal pressure generation is altered in patients with a history of radiotherapy can help clinicians form more precise treatment plans.
头颈部癌症放射治疗相关的吞咽困难较为复杂，且难以治疗。视频透视吞咽研究（VFSS）是目前用于吞咽评估的金标准仪器。高分辨率测压法（HRM）是另一种方法，可提供咽和食管相关吞咽压力的客观测量。这可以为食团推进的压力梯度提供功能信息，对于该患者群体非常相关，因为放射性纤维化会导致肌肉无力和压力产生受损。本初步研究的目的是使用 HRM 描述放射性相关吞咽困难（RAD）和晚期放射性相关吞咽困难（LRAD）患者的咽部吞咽压力。RAD 发生在治疗期间和治疗后立即，而 LRAD 是一种较新描述的现象，即患者在治疗后至少 5 年出现吞咽困难。我们对 21 例 RAD 或 LRAD 患者和 21 例健康的性别/年龄匹配对照者的咽部吞咽压力进行了回顾性分析。RAD 或 LRAD 患者的整个咽部吞咽压力持续时间均缩短（p ≤ 0.002），咽下部最大压力（p = 0.003）和咽部收缩积分（p < 0.0001）均降低。了解接受过放射治疗的患者的咽压力产生情况如何变化有助于临床医生制定更精确的治疗计划。
