Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Head Neck. 2021 Oct;43(10):2883-2895. doi: 10.1002/hed.26768. Epub 2021 Jun 3.
To describe the physiologic swallowing impairments (MBSImP™©) associated with safety/efficiency impairments (DIGEST /DIGEST grades) at 3-6 months after transoral robotic surgery (TORS) or radiation therapy (RT).
Secondary analysis of registry data.
Single, academic institution.
Two hundred and fifty-seven patients with HPV+ oropharynx cancer were stratified by primary treatment (75 TORS, 182 RT). Modified barium swallow studies were analyzed at baseline and 3-6 months using MBSImP scores and DIGEST /DIGEST grades. DIGEST /DIGEST grades and MBSImP were compared groupwise and associations between DIGEST /DIGEST grades and MBSImP were explored by ordinal logistic regression. Exploratory analyses were stratified by multimodality treatment.
Neither DIGEST /DIGEST differed significantly between groups at baseline or 3-6 months. Laryngeal vestibule closure was impaired more frequently in the RT group (RT: 41% vs. TORS: 27%; p = 0.02) while the TORS group had significantly more pharyngeal contraction impairment (63%; p < 0.001) compared to RT at 3-6 months.
The results suggest a focal injury associated with DIGEST /DIGEST post-TORS in contrast to a low-level diffuse physiologic impairment associated with post-RT dysphagia.
描述经口机器人手术（TORS）或放射治疗（RT）后 3-6 个月时与安全性/效率障碍（DIGEST/DIGEST 分级）相关的生理吞咽障碍（MBSImP™©）。
注册数据的二次分析。
单一学术机构。
将 257 名 HPV+口咽癌患者按主要治疗方法分层（75 例 TORS，182 例 RT）。使用 MBSImP 评分和 DIGEST/DIGEST 分级在基线和 3-6 个月时对改良钡吞咽研究进行分析。对 DIGEST/DIGEST 分级和 MBSImP 进行组间比较，并通过有序逻辑回归探索 DIGEST/DIGEST 分级与 MBSImP 之间的相关性。通过多模态治疗进行探索性分析分层。
基线和 3-6 个月时，DIGEST/DIGEST 分级在两组之间均无显著差异。RT 组的喉前庭闭合障碍更为频繁（RT：41%比 TORS：27%；p = 0.02），而 TORS 组在 3-6 个月时的咽收缩障碍更为严重（63%；p<0.001）。
结果表明，TORS 后与 DIGEST/DIGEST 相关的损伤是局灶性的，而 RT 后与吞咽困难相关的损伤是低水平的弥散性生理损伤。
