Article

The aim of this study was to objectively assess swallowing function and factors
impacting it after curative intent definitive (chemo)radiotherapy (CRT) for head
and neck squamous cell carcinoma (HNSCC). Swallowing function was studied in a
cohort of 47 patients with locoregionally advanced (T1-4, N0-3) HNSCC treated
with definitive CRT. Objective assessment of swallowing function was done using
modified barium swallow (MBS) at baseline (pre-CRT) and subsequent follow-ups.
Scoring of MBS was done using penetration-aspiration scale (PAS). Abnormal
swallowing was defined in terms of incidence and severity of
penetration-aspiration, pharyngeal residue, postural change, and regurgitation.
Aspiration, residual, postural change, and regurgitation were present on baseline
pre-CRT assessment in 9 (19%), 11 (23%), 10 (21%), and 5 (10%) patients that
increased to 11 (29%), 11 (29%), 12 (32%), and 10 (26%) patients, respectively,
at 6-month post-CRT evaluation. The proportion of patients with high PAS scores
(3-7) increased from 27% at baseline to 37% at 6-month post-CRT evaluation. Among
patients (n = 34) with low PAS scores (</=2) at baseline, additional impairment
of swallowing function was seen in 53 and 46% at 2- and 6-month assessment,
respectively. Residue (44%) and aspiration (18%) domains were impaired in a
higher proportion of patients after CRT. Thin and thick barium had higher
aspiration and residue function impairment, respectively. Patients with pre-CRT
poor subjective swallowing function (P = 0.004), hypopharyngeal primary (P =
0.05), and large tumor volume (P = 0.05) had significantly worse objective
swallowing function at baseline as demonstrated by pretreatment PAS scores. This
study provides useful information regarding patterns of objective swallowing
dysfunction in patients treated with definitive (chemo)radiotherapy. There is
significant impairment of objective swallowing function in all domains following
CRT, with residue and aspiration domains being affected most significantly.

Langue : ANGLAIS