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Characteristics Associated With Swallowing Changes After Concurrent Chemotherapy and Radiotherapy in Patients With Head and Neck Cancer
Joseph K. Salama, MD;
Kerstin M. Stenson, MD;
Marcy A. List, PhD;
Loren K. Mell, MD;
Ellen MacCracken, MS;
Ezra E. Cohen, MD;
Elizabeth Blair, MD;
Everett E. Vokes, MD;
Daniel J. Haraf, MD
Arch Otolaryngol Head Neck Surg. 2008;134(10):1060-1065.
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.
Author Affiliations: Department of Radiation and Cellular Oncology (Drs Salama, Mell, Vokes, and Haraf), Section of Otolaryngology–Head and Neck Surgery (Drs Stenson and Blair and Ms MacCracken), Cancer Research Center (Drs Salama, Stenson, List, Cohen, Blair, Vokes, and Haraf), Center for Speech and Swallowing Disorders (Ms MacCracken), and Section of Hematology/Oncology (Drs Cohen and Vokes), University of Chicago, Chicago, Illinois.
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