Ku Peter K M, Vlantis Alexander C, Wong Rita W M, Hui Thomas S C, Law Thomas, Ng Louisa K Y, Wong Eddy W Y, Chang W T, Johnson David R, Mok Florence S T, Wong K H, Abdullah Victor, van Hasselt Andrew, Lee Kathy Y S, Tong Michael C F
Department of Otorhinolaryngology - Head and Neck Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin New Territories Hong Kong.
Department of Otorhinolaryngology - Head and Neck Surgery United Christian Hospital and Tseung Kwan O Hospital Tseung Kwan O Hong Kong.
Laryngoscope Investig Otolaryngol. 2023 Oct 14;8(6):1532-1546. doi: 10.1002/lio2.1162. eCollection 2023 Dec.
Exercise-based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy.
Patients with early post-radiotherapy NPC ( = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy-nasopharyngeal (FACT-NP) questionnaire.
Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post-radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small-to-medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT-NP than the EBST group.
Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations.
1B.
基于运动的吞咽训练（EBST）和经皮神经肌肉电刺激（TNMES）是用于治疗鼻咽癌（NPC）放疗后晚期吞咽困难的常用方法。我们旨在研究和比较EBST和TNMES作为放疗后早期进行的预防性治疗的疗效。
放疗后早期的NPC患者（n = 120）接受TNMES或EBST治疗。在干预前以及干预后即刻、6个月和12个月完成吞咽功能的灵活内镜评估（FEES）、生活质量（QOL）和吞咽功能问卷。结局指标包括吞咽功能评分（SFS）、渗透和误吸量表（PAS）、吞咽毒性动态影像分级（DIGEST）、功能性经口进食量表（FOIS）、吞咽表现状态量表（SPSS）、咽部运动障碍（PMI）、咽部功能障碍（PFI）以及癌症治疗后鼻咽部功能评估（FACT-NP）问卷的得分。
放疗后3个月，分别有31例和34例患者接受TNMES和EBST治疗，并在所有四个评估时间点完成吞咽评估。所有患者在SFS、PAS、DIGEST、PMI和PFI方面均表现出放疗后功能障碍。与EBST组相比，TNMES组在PFI和PMI评分方面有显著改善，效应量为小到中等。此外，与EBST组相比，TNMES组在干预后即刻和6个月时，PAS、DIGEST、FOIS和SPSS评分有略有更好改善的趋势。两组的SFS评分均较基线有所改善；然而，TNMES组改善更早。最后，根据FACT-NP问卷，TNMES组的生活质量优于EBST组。
放疗后早期给予预防性TMNES和EBST是改善NPC患者吞咽功能的安全可行方法。尽管TNMES的结果优于EBST，但鉴于研究局限性，这些结果应谨慎解读。
1B。
