Ellen MacCracken

Swallowing disorders in the first year after radiation and chemoradiation

Radiation alone or concurrent chemoradiation can result in severe swallowing disorders. This manuscript defines the swallowing disorders occurring at pretreatment and 3 and 12 months after completion of radiation or chemoradiation.

Xerostomia: 12‐Month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation

Previous investigators have found permanent changes in saliva production after chemoradiation but have not examined these in relation to swallowing measures, diet changes, and patient comfort over time.

Pretreatment swallowing function in patients with head and neck cancer

Few objective data characterizing the pretreatment swallow function of patients with head and neck cancer are available.

Swallow function and perception of dysphagia in patients with head and neck cancer

The relationship between subjective complaints of dysphagia and objective measures of swallow function in patients with cancers of the oral cavity, pharynx, or larynx, treated with radiotherapy ± chemotherapy has not been well documented in the literature.

SITE OF DISEASE AND TREATMENT PROTOCOL AS CORRELATES OF SWALLOWING FUNCTION IN PATIENTS WITH HEAD AND NECK CANCER TREATED WITH CHEMORADIATION

The relationship between type of chemoradiation treatment, site of disease, and swallowing function has not been sufficiently examined in patients with head and neck cancer treated primarily with chemoradiation.

Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy

Current research demonstrates that swallow function is impaired after treatment with organ‐sparing chemoradiotherapy. Few studies, however, have related observed swallowing disorders with the patients oral intake and diet in a large cohort of patients.

Effects of radiotherapy with or without chemotherapy on tongue strength and swallowing in patients with oral cancer.

Oral tongue strength and swallowing ability are reduced in patients treated with chemoradiotherapy for oral and oropharyngeal cancer.

EATING ABILITY IN HEAD AND NECK CANCER PATIENTS AFTER TREATMENT WITH CHEMORADIATION: A 12-MONTH FOLLOW-UP STUDY ACCOUNTING FOR DROPOUT

Head and neck cancer patients treated with chemoradiation have difficulty eating a normal diet. This study was designed to characterize eating ability over 12 months after chemoradiation treatment. Analyses take patient dropout into account.

Characteristics Associated With Swallowing Changes After Concurrent Chemotherapy and Radiotherapy in Patients With Head and Neck Cancer

OBJECTIVE To define factors that acutely influenced swallowing function prior to and during concurrent chemotherapy and radiotherapy. DESIGN A summary score from 1 to 7 (the swallowing performance status scale [SPS]) of oral and pharyngeal impairment, aspiration, and diet, was assigned to each patient study by a single senior speech and swallow pathologist, with higher scores indicating worse swallowing. Generalized linear regression models were formulated to asses the effects of patient factors (performance status, smoking intensity, amount of alcohol ingestion, and age), tumor factors (primary site, T stage, and N stage), and treatment-related factors (radiation dose, use of intensity-modulated radiation therapy, response to induction chemotherapy, postchemoradiotherapy neck dissection, and preprotocol surgery) on the differences between SPS score before and after treatment. SETTING University hospital tertiary care referral center. PATIENTS The study included 95 patients treated under a multiple institution, phase 2 protocol who underwent a videofluorographic oropharyngeal motility (OPM) study to assess swallowing function prior to and within 1 to 2 months after the completion of concurrent chemotherapy and radiotherapy. MAIN OUTCOME MEASURES Factors associated with swallowing changes after chemoradiotherapy. RESULTS The mean pretreatment and posttreatment OPM scores were 3.09 and 3.77, respectively. Patients with T3 or T4 tumors (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.15-0.95; P = .04) and a performance status of 1 or 2 (OR, 0.37; 95% CI, 0.15-0.91; P = .03) were less likely to have worsening of swallowing after chemoradiotherapy. There was a trend for worse swallowing with increasing age (OR, 1.04; 95% CI, 0.99-1.09; P = .08). Only T stage (T3 or T4) was associated with improved swallowing after treatment (OR, 8.96; 95% CI, 1.9-41.5; P < .001). CONCLUSION In patients undergoing concurrent chemotherapy and radiotherapy, improved swallowing function over baseline is associated with advanced T stage.

Chemoradiation for patients with large-volume laryngeal cancers.

Patients with T4 laryngeal cancers, including those with large‐volume (cartilage or tongue‐base invasion) lesions, are often excluded from organ‐preservation trials due to expectations of inferior outcome in terms of survival and function. We hypothesize that such patients indeed have acceptable survival and function when treated with organ‐preservation strategies.