Radiation-Associated Chronic Dysphagia Assessment by Flexible Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients: Swallowing-Related Structures and Radiation Dose-Volume Effect.

Abstract

PURPOSE:

We aimed to restore dose-volume parameters of swallowing-related structures (SRSs) by evaluating long-term swallowing dysfunctions after radiotherapy (RT) in head and neck cancer patients (HNCPs).

MATERIALS AND METHODS:

Head and neck cancer patients whose pharyngeal region was involved in RT portal and treated with definitive RT/chemoradiotherapy (CRT) were included in the analyses. Patients underwent objective swallowing assessment by flexible endoscopic evaluation of swallowing (FEES). Volumes of SRSs that received 55 Gy (V55) (mean dose [Dmean]) were evaluated according to the dose-volume histograms of each patient. For every SRS, optimal dose-volume cut-off values were determined by receiver operating characteristic curve analysis.

RESULTS:

Fifty-five patients at a median 20 months (range, 12-26 months) after their treatments were evaluated. There was a strong negative correlation between FEES scores and dose-volume parameters of SRS ( r ⩽ -0.5, P < .0001). According to our results, middle pharyngeal constrictor (MPC) and inferior pharyngeal constrictor (IPC) had a Dmean > 57 Gy, base of tongue (BOT) Dmean > 50 Gy, supraglottic larynx (SGL) and glottic larynx (GL) Dmean > 55 Gy, and cervical esophagus (CE) Dmean > 45 Gy. MPC V55 > 70%, IPC V55 > 50%, BOT V55 > 65%, CE V55 > 40%, and SGL and GL V55 > 50% were significant predictors for dysphagia.

CONCLUSION:

It was found that dysphagia correlates strongly with dose-volume parameters of SRSs. IPC, SGL, and CE were found to be structures significantly associated with dysphagia.

• Authors: Ozlem Ozkaya Akagunduz, Sibel Eyigor, Esra Kirakli, Emin Tavlayan, Zeynep Erdogan Cetin, Gulsen Kara, Mustafa Esassolak
• Journal: The Annals of otology, rhinology, and laryngology (Ann Otol Rhinol Laryngol) Vol. 128 Issue 2 Pg. 73-84 (Feb 2019) ISSN: 1943-572X [Electronic] United States
• PMID: 30343589 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Chemoradiotherapy (adverse effects)
• Chronic Disease
• Deglutition Disorders (diagnosis, etiology, physiopathology)
• Dose-Response Relationship, Radiation
• Endoscopy (instrumentation, methods)
• Esophagus (physiopathology, radiation effects)
• Female
• Head and Neck Neoplasms (radiotherapy)
• Humans
• Larynx (physiopathology, radiation effects)
• Male
• Middle Aged
• Pharynx (physiopathology, radiation effects)
• Radiation Injuries (diagnosis, physiopathology)
• Radiotherapy Dosage
• Young Adult