Sellstrom Diane, Patterson Joanne M, Finch Tracy, O'Hara James, Haighton Catherine
The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK.
Dept. Speech, Voice and Swallowing, Freeman Hospital, Freeman Road, Newcastle-Upon-Tyne, UK.
Support Care Cancer. 2025 May 22;33(6):493. doi: 10.1007/s00520-025-09540-4.
To provide an overview of existing literature reporting swallowing outcomes beyond two years post- head and neck cancer treatment. Objectives were to establish prevalence of late radiation-associated dysphagia (-RAD); identify risk factors of developing late-RAD and synthesise the dysphagia findings reported.
The PRISMA-ScR checklist for conducting scoping reviews was adopted. Searches of PubMed, EMBASE, Scopus, CINAHL, Web of Science, OpenGrey, Google Scholar and Google Advanced were completed by December 2022. Eligibility criteria included studies written in English from 1996 reporting swallowing outcomes from 2 years or more post-treatment. Data was extracted from included studies, tabulated, synthesised and reported as categories.
Screening 7671 studies resulted in 39 studies included in the review. There was wide variation in dysphagia outcome measures used and timing of collection across studies. Prevalence could not be established. All studies reported a degree of impairment in at least one measure in a proportion of patients. Numerous risk factors were identified (including tumour site, and T-classification, age, radiotherapy dose), but there were conflicting findings and meaningful synthesis was challenging. Characteristics of late-RAD included high aspiration rates; reduced efficiency of swallowing and lower cranial neuropathy.
Significant gaps exist in the evidence base regarding late-RAD such as who is affected, why and what the trajectory of decline will be. Swallowing safety is often compromised. A consensus on the definition of late-RAD is needed along with increased uniformity in collection of outcome measures, in order to improve understanding and guide future research and service delivery models.
概述现有关于头颈癌治疗两年后吞咽结果的文献。目标是确定晚期放射性吞咽困难（-RAD）的患病率；识别发生晚期RAD的风险因素，并综合所报告的吞咽困难研究结果。
采用PRISMA-ScR清单进行范围综述。截至2022年12月，完成了对PubMed、EMBASE、Scopus、CINAHL、Web of Science、OpenGrey、谷歌学术和谷歌高级搜索的检索。纳入标准包括1996年以来用英文撰写的报告治疗后两年或更长时间吞咽结果的研究。从纳入研究中提取数据，制成表格，进行综合并按类别报告。
筛选7671项研究后，有39项研究纳入综述。各研究中使用的吞咽困难结果测量方法和收集时间差异很大。无法确定患病率。所有研究均报告了一定比例的患者至少在一项测量中有某种程度的损伤。确定了许多风险因素（包括肿瘤部位、T分期、年龄、放疗剂量），但研究结果相互矛盾，进行有意义的综合具有挑战性。晚期RAD的特征包括高误吸率、吞咽效率降低和下颅神经病变。
关于晚期RAD的证据基础存在重大差距，例如哪些人会受到影响、原因以及病情下降的轨迹。吞咽安全常常受到损害。需要就晚期RAD的定义达成共识，并提高结果测量收集的一致性，以增进理解并指导未来的研究和服务提供模式。
