TY - JOUR
T1 - Relationship between videofluoroscopic and subjective (physician- and patient- rated) assessment of late swallowing dysfunction after (chemo) radiation
T2 - Results of a prospective observational study
AU - Gawryszuk, Agata
AU - Bijl, Hendrik P.
AU - van der Schaaf, Arjen
AU - Perdok, Nathalie
AU - Wedman, Jan
AU - Verdonck-de Leeuw, Irma M.
AU - Rinkel, Rico N.
AU - Steenbakkers, Roel J. H. M.
AU - van den Hoek, Johanna G. M.
AU - van der Laan, Hans Paul
AU - Langendijk, Johannes A.
N1 - Funding Information: The study described in the paper was part of a larger project granted by the Dutch Cancer Society (RUG 2008-3983). Publisher Copyright: © 2021 The Authors
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Background and purpose: Primary (chemo)radiation (CHRT) for HNC may lead to late dysphagia. The purpose of this study was to assess the pattern of swallowing disorders based on prospectively collected objective videofluoroscopic (VF) assessment and to assess the correlations between VF findings and subjective (physician- and patient-rated) swallowing measures. Material and methods: 189 consecutive HNC patients receiving (CH)RT were included. Swallowing evaluation at baseline and 6 months after treatment (T6) encompassed: CTCAE v.4.0 scores (aspiration/dysphagia), PROMs: SWAL QOL/ EORTC QLQ-H&N35 (swallowing domain) questionnaires and VF evaluation: Penetration Aspiration Scale, semi-quantitative swallowing pathophysiology evaluation, temporal measures and oral/pharyngeal residue quantification. Aspiration specific PROMs (aPROMs) were selected. Correlations between late penetration/aspiration (PA_T6) and: clinical factors, CTCAE and aPROMs were assessed using uni- and multivariable analysis. Results: Prevalence of PA increased from 20% at baseline to 43% after treatment (p < 0.001). The most relevant baseline predictors for PA_T6 were: PA_T0, age, disease stage III–IV, bilateral RT and baseline aPROM ‘Choking when drinking’ (AUC: 0.84). In general aPROMs correlated better with VF-based PA than CTCAE scores. The most of physiological swallowing components significantly correlated and predictive for PA (i.e. Laryngeal Vestibular Closure, Laryngeal Elevation and Pharyngeal Contraction) were prone to radiation damage. Conclusion: The risk of RT-induced PA is substantial. Presented prediction models for late penetration/aspiration may support patient selection for baseline and follow-up VF examination. Furthermore, all aspiration related OARs involved in aforementioned swallowing components should be addressed in swallowing sparing strategies. The dose to these structures as well as baseline PROMs should be included in future NTCP models for aspiration.
AB - Background and purpose: Primary (chemo)radiation (CHRT) for HNC may lead to late dysphagia. The purpose of this study was to assess the pattern of swallowing disorders based on prospectively collected objective videofluoroscopic (VF) assessment and to assess the correlations between VF findings and subjective (physician- and patient-rated) swallowing measures. Material and methods: 189 consecutive HNC patients receiving (CH)RT were included. Swallowing evaluation at baseline and 6 months after treatment (T6) encompassed: CTCAE v.4.0 scores (aspiration/dysphagia), PROMs: SWAL QOL/ EORTC QLQ-H&N35 (swallowing domain) questionnaires and VF evaluation: Penetration Aspiration Scale, semi-quantitative swallowing pathophysiology evaluation, temporal measures and oral/pharyngeal residue quantification. Aspiration specific PROMs (aPROMs) were selected. Correlations between late penetration/aspiration (PA_T6) and: clinical factors, CTCAE and aPROMs were assessed using uni- and multivariable analysis. Results: Prevalence of PA increased from 20% at baseline to 43% after treatment (p < 0.001). The most relevant baseline predictors for PA_T6 were: PA_T0, age, disease stage III–IV, bilateral RT and baseline aPROM ‘Choking when drinking’ (AUC: 0.84). In general aPROMs correlated better with VF-based PA than CTCAE scores. The most of physiological swallowing components significantly correlated and predictive for PA (i.e. Laryngeal Vestibular Closure, Laryngeal Elevation and Pharyngeal Contraction) were prone to radiation damage. Conclusion: The risk of RT-induced PA is substantial. Presented prediction models for late penetration/aspiration may support patient selection for baseline and follow-up VF examination. Furthermore, all aspiration related OARs involved in aforementioned swallowing components should be addressed in swallowing sparing strategies. The dose to these structures as well as baseline PROMs should be included in future NTCP models for aspiration.
KW - (Chemo)radiation
KW - Aspiration
KW - Dysphagia
KW - Head and neck cancer
KW - Videofluoroscopy
UR - http://www.scopus.com/inward/record.url?scp=85117370486&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.radonc.2021.09.017
DO - https://doi.org/10.1016/j.radonc.2021.09.017
M3 - Article
C2 - 34592362
SN - 0167-8140
VL - 164
SP - 253
EP - 260
JO - Radiotherapy and oncology
JF - Radiotherapy and oncology
ER -