Luisa Locantore

How does radiotherapy impact swallowing function in nasopharynx and oropharynx cancer? Short-term results of a prospective study

SUMMARY The objective of this study is to report the initial results of a prospective trial assessing instrumental deglutition function in nasopharynx and oropharynx cancers after radio or chemoradiotherapy using intensity-modulated radiotherapy (IMRT). IMRT was delivered aiming to spare the swallowing organ at risk (SWOARs) for Stage II-IV naso- and oropharynx cancer. Objective instrumental assessment included videofluoroscopy (VFS), fiberoptic endoscopic evaluation of swallowing (FEES) and oro-pharyngeal-oesophageal scintigraphy (OPES) at baseline and at 1 month after radiotherapy. Dysphagia parameter scores were calculated at each exam after liquid (L) and semi-liquid (SL) bolus intake: pre-deglutition penetration, aspiration, pharyngeal transit time (PTT) and hypopharyngeal retention index (HPRI). Overall, 20 patients (6 nasophaynx and 14 oropharynx) completed treatment and instrumental assessment after 1 month. Comparison between pre- and post-treatment HPRI score values showed a significant worsening in both FEES-L (p = 0.021) and SL (p = 0.02) and at VFS-L (p = 0.008) and SL (p = 0.005). Moreover, a relationship between HPRI worsening at FEES-L and FEES-SL (p = 0.005) as well as at VFS-L and VFS-SL (p < 0.001) was observed. PTT was not significantly affected by radiotherapy (p > 0.2). Only a few patients experienced pre-deglutition penetration (1 patient with base of tongue cancer at FEES-L and SL) and aspiration (1 patient with nasopharynx cancer at OPES-L and FEES-SL) after radiotherapy. Our early results showed that IMRT-SWOARs sparing caused a significant increase in the post-deglutition HPRI score. Longer follow-up will be necessary to evaluate if the increase of HPRI is related to a high risk of developing late aspiration.

The Value of Oro-Pharyngo-Esophageal Scintigraphy in the Management of Patients with Aspiration into the Tracheo-bronchial Tree and Consequent Dysphagia.

Context: Tracheo-bronchial aspiration is the most invalidating condition which can happen to patients affected by dysphagia, especially when caused by central neurologic disorders; the associated pneumonia episodes represent the most frequent cause of death in these patients. Oro-pharyngo-esophageal scintigraphy (OPES) allows both functional imaging and semiquantitative evaluation of the subsequent phases of swallowing. Case Report: We evaluated by means of OPES a woman who had previously undergone high-dose external beam radiation therapy for a nasopharyngeal carcinoma, which determined tissue fibrosis and progressive dysphagia. Conclusion: In this patient with dysphagia, OPES was a simple, inexpensive, noninvasive, and reliable technique that allowed to show the presence of bolus aspiration and quantified tracheobronchial aspirate.

Tecniche diagnostiche per lo studio del sistema linfatico

Il termine “sistema linfatico” indica l’insieme delle vie e degli organi linfatici. Da un punto di vista anatomo-funzionale, questo sistema si pone a meta tra l’apparato circolatorio e il sistema immunitario. Gli organi linfatici (milza, timo, anello linfatico faringeo, tessuto linfatico dell’intestino) presentano un elevato contenuto di tessuto connettivo reticolare e di linfociti, fondamentali per le difese immunitarie; alterazioni del sistema linfatico si ripercuotono, infatti, negativamente sull’efficacia delle reazioni immunitarie dell’organismo. Le vie linfatiche sono costituite da un articolato sistema di vasi, molto simile a quello circolatorio venoso e arterioso, deputati al trasporto della linfa. Lungo il loro decorso si trovano intercalati i linfonodi, formazioni di tessuto linfoide che ricevono la linfa dai vasi; tali strutture possono essere singole o raggruppate, e avere dimensioni molto piccole. Tuttavia, in alcune sedi i linfonodi raggiungono un volume ragguardevole e sono riuniti in gruppi anche molto numerosi (linfocentri) verso i quali convergono vasi che raccolgono la linfa da estese regioni del corpo. I linfonodi costituiscono vere e proprie stazioni del sistema, con funzione di filtro e di deposito; inoltre, essi permettono la maturazione dei linfociti, consentendo la loro attivazione e l’incontro delle cellule di difesa mature con gli antigeni e con gli agenti patogeni.