Yildiz Erdem, Grasl Stefan, Denk-Linnert Doris-Maria, Altorjai Gabriela, Herrmann Harald, Grasl Matthaeus C, Erovic Boban M, Janik Stefan
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2022 May 10;11(10):2688. doi: 10.3390/jcm11102688.
Objective: To evaluate the impact of radiotherapy (RT) on dysphagia and long-term swallowing outcome in patients with stage III and IV head and neck squamous cell carcinomas (HNSCCs). Material and Methods: Between 2005 and 2008, 189 patients with HNSCCs underwent primary or adjuvant RT in a curative setting. Long-term swallowing outcome was evaluated in 50 patients. Among them, 26 were further eligible for prospective analysis of long-term swallowing and dysphagia outcome. Medical charts were retrospectively reviewed regarding pre- and post-treatment dysphagia (3 months after last irradiation setting) as well as persisting long-term dysphagia (2019−2021). Results: Pre-treatment dysphagia was observed in 24 (48%) of 50 patients, particularly in oropharyngeal or hypopharyngeal stage III−IV tumors (OR 9.3; p = 0.003). Conversely, 46 patients (92%) complained about post-treatment dysphagic symptoms, which were more commonly seen in patients with positive neck nodes (OR 10.5; p = 0.037). The post-treatment dysphagia rate dropped from 92% to 24% (p < 0.001) during surveillance, which was significantly linked to xerostomia (OR 5.77; p = 0.019), dysgeusia (OR 9.9; p = 0.036) and free flap reconstruction (OR 6.1; p = 0.022). Conclusion: Pretreatment dysphagia is common in advanced stage HNSCCs and almost all patients complain about dysphagia at the end of RT. Importantly, applied RT protocols did not affect long-term dysphagia, which improves significantly in the majority of patients over time. Meeting Information: Preliminary results have been presented at the 65th Annual Meeting of the Austrian Society of Otorhinolaryngology, 22−26 September 2021, Austria.
评估放疗（RT）对Ⅲ期和Ⅳ期头颈部鳞状细胞癌（HNSCC）患者吞咽困难及长期吞咽结局的影响。材料与方法：2005年至2008年期间，189例HNSCC患者在根治性治疗中接受了根治性或辅助性放疗。对50例患者的长期吞咽结局进行了评估。其中，26例患者进一步符合长期吞咽和吞咽困难结局的前瞻性分析条件。回顾性查阅病历，了解治疗前和治疗后（最后一次放疗结束后3个月）的吞咽困难情况以及持续存在的长期吞咽困难（2019 - 2021年）。结果：50例患者中有24例（48%）存在治疗前吞咽困难，尤其在口咽或下咽Ⅲ - Ⅳ期肿瘤患者中（比值比9.3；p = 0.003）。相反，46例患者（92%）出现治疗后吞咽困难症状，在颈部淋巴结阳性患者中更常见（比值比10.5；p = 0.037）。在随访期间，治疗后吞咽困难发生率从92%降至24%（p < 0.001），这与口干（比值比5.77；p = 0.019）、味觉障碍（比值比9.9；p = 0.036）和游离皮瓣重建（比值比6.1；p = 0.022）显著相关。结论：治疗前吞咽困难在晚期HNSCC中很常见，几乎所有患者在放疗结束时都会出现吞咽困难。重要的是，应用的放疗方案并未影响长期吞咽困难，随着时间的推移，大多数患者的吞咽困难情况有显著改善。会议信息：初步结果已在2021年9月22日至26日于奥地利举行的奥地利耳鼻咽喉科学会第65届年会上发表。
