Lisa A. Newman

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.

Aspiration: Cause and Implications:

The purpose of this investigation was to determine the overall prevalence of aspiration in dysphagic individuals referred for a modified barium swallow and the underlying anatomic and/or physiologic causes. A total of 166 patients were seen during a 1-month period at 5 participating institutions. Aspiration was detected in 51.2% of the patients. The most common causes were decreased laryngeal elevation and delayed triggering of the pharyngeal motor response. A history of aspiration pneumonia was significantly associated with the presence of aspiration on modified barium swallow study. The presence of a protective cough was present in only 53% of patients who aspirated, reinforcing the need for appropriate radiologic assessment in patients with suspected dysphagia.

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.

Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation

RADPLAT (concurrent selective supradose intraarterial cisplatin and external‐beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech.

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.

Factors predictive of poor functional outcome after chemoradiation for advanced laryngeal cancer.

OBJECTIVE: The study goal was to determine whether pretreatment parameters can be used to predict poor outcomes related to laryngeal function among survivors after organ preservation therapy for advanced laryngeal cancer. DESIGN: A retrospective analysis of patients treated in an ongoing chemoradiation trial. SETTING: Academic tertiary care referral medical center. PATIENTS AND METHODS: Among the 65 patients receiving concomitant intra-arterial cisplatin and radiation therapy for stage III and IV laryngeal cancer between 1993 and 1999, we identified 45 who were available for follow-up and were disease free 6 months after the completion of therapy. A nominal logistic regression analysis was performed to study the effect of age, gender, T and N classification, vocal cord fixation, massive cartilage destruction, and neck dissection on the likelihood of requiring a tracheostomy tube for breathing and/or a gastrostomy tube for feeding at 6 months after the completion of therapy. MAIN OUTCOME MEASURE: Persistent use of gastrostomy tube feedings and/or tracheostomy at 6 months after the completion of therapy. RESULTS: Sixteen patients (36%) required a feeding tube and/or a tracheostomy (tracheostomy 13, gastrostomy 13, both 10). Regression analysis of all pretreatment factors indicated vocal cord fixation as being the strongest predictor of a poor functional outcome (defined as the persistent need for a feeding tube and/or tracheostomy at 6 months after therapy). Among the 27 patients in this subset, 15 (56%) had a poor functional outcome. In contrast, only 1 (6%) of 18 patients without vocal cord fixation had poor laryngeal function. Although the history of pulmonary disease was not a significant parameter by itself, when combined with vocal cord fixation, 6 of 8 patients had a poor functional outcome. CONCLUSION: Pretreatment parameters may be used to predict a poor functional outcome after chemoradiation. Because of the high likelihood of poor function, laryngeal cancer patients seeking organ preservation therapy with chemoradiation should be cautioned if they present with a fixed vocal cord.