Gitto Marco, Mozzanica Francesco, Porpiglia Vincenzo, Morelli Luca, Ninfa Aurora, Selvagio Alessandro, Rocca Sara, Pizzorni Nicole, Schindler Antonio
Department of Phoniatrics and Logopedics, Buzzi Children's Hospital, 20154 Milan, Italy.
Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy.
Curr Oncol. 2025 Apr 16;32(4):233. doi: 10.3390/curroncol32040233.
Late radiation-associated dysphagia (late-RAD) remains a challenge in head and neck cancer (HNC) survivorship, despite advancements in treatment methods. Although Fiberoptic Endoscopic Evaluation of Swallowing (FEES) stands as the preferred diagnostic approach for oropharyngeal dysphagia assessment in the HNC population, current studies lack a FEES-derived swallowing parameter characterization and phenotypic classification within this specific cohort. This study sought to employ FEES-based assessment to characterize swallowing safety and efficacy profiles, identify distinct phenotypes in HNC patients suffering from late-RAD, and examine potential correlations between safety and efficacy parameters. A retrospective analysis included twenty-four post-radiotherapy HNC patients evaluated using standardized FEES protocols across three bolus consistencies (liquid, semisolid, and solid). Swallowing safety was quantified using the Penetration-Aspiration Scale (PAS), while efficacy was measured via the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Additionally, six distinct dysphagia phenotypes were characterized within the cohort. Propulsion deficit was the predominant phenotype (92%), followed by delayed pharyngeal phase (37.5%) and protective deficit (25%), with 46% of patients exhibiting multiple phenotypes. Unsafe swallowing occurred most frequently with liquid consistency (62.5%), while residue was most prevalent with semisolid (82.6% valleculae, 52.2% pyriform sinuses) and solid consistencies (92.3% valleculae, 53.8% pyriform sinuses). Significant correlations were found between penetration-aspiration and pharyngeal residue scores across consistencies ( < 0.05). FEES examination revealed distinct phenotypes in late radiation-associated dysphagia, with a predominance of propulsion deficit and significant interdependence between safety and efficacy parameters.
尽管治疗方法有所进步，但晚期放射性吞咽困难（late-RAD）仍是头颈癌（HNC）幸存者面临的一项挑战。虽然纤维内镜吞咽评估（FEES）是HNC患者口咽吞咽困难评估的首选诊断方法，但目前的研究缺乏该特定队列中基于FEES的吞咽参数特征描述和表型分类。本研究旨在采用基于FEES的评估来描述吞咽安全性和有效性概况，识别患有晚期RAD的HNC患者的不同表型，并检查安全性和有效性参数之间的潜在相关性。一项回顾性分析纳入了24例放疗后的HNC患者，这些患者使用标准化FEES方案对三种团块稠度（液体、半固体和固体）进行了评估。吞咽安全性使用渗透-误吸量表（PAS）进行量化，而有效性则通过耶鲁咽残留严重程度评定量表（YPRSRS）进行测量。此外，在该队列中确定了六种不同的吞咽困难表型。推进障碍是主要表型（92%），其次是咽期延迟（37.5%）和保护障碍（25%），46%的患者表现出多种表型。不安全吞咽在液体稠度时最常发生（62.5%），而残留最常见于半固体（会厌谷82.6%，梨状窦52.2%）和固体稠度（会厌谷92.3%，梨状窦53.8%）。在不同稠度下，渗透-误吸与咽残留评分之间存在显著相关性（<0.05）。FEES检查揭示了晚期放射性吞咽困难的不同表型，以推进障碍为主，且安全性和有效性参数之间存在显著的相互依存关系。
