The Relationships Between Radiation Dosage and Long-term Swallowing Kinematics and Timing in Nasopharyngeal Carcinoma Survivors

Swallowing Kinematics in Male Patients with Total Laryngectomy

OBJECTIVE

The present study aimed to investigate the symptomatic swallowing complaints in individuals with total laryngectomy (TL) and reveal how swallowing kinematics differs between those with and without symptomatic dysphagia complaints.

METHODS

A total of 34 subjects with TL were included in the study. Swallowing kinematics of those with symptomatic swallowing complaints (Group 1) were compared to those without (Group 2). Kinematic parameters including pharyngeal transit duration (PTD), maximum pharyngeal constriction ratio (MPCR), upper esophageal sphincter opening ratio (UESOR), upper esophageal sphincter opening duration (UESOD), and bolus clearance ratio (BCR) were investigated from Videofluoroscopic Swallowing Study (VFSS) records via ImageJ software.

RESULTS

Symptomatic swallowing complaints were determined in 47.1% of the subjects (n = 16). Difficulty while swallowing solid foods and pills, diminished pleasure of eating, food getting stuck in the throat, and increased level of stress during swallowing were among the major swallowing complaints in the present cohort. PTD, MPCR, and BCR parameters were significantly higher in subjects with symptomatic swallowing complaints than those without.

CONCLUSION

These preliminary findings indicate that almost half of individuals with TL may have symptomatic swallowing complaints. The underlying pathophysiology of this phenomenon may be the devianced kinematic parameters including PTD, MPCR, and BCR in this population. Therefore, it is recommended to include the kinematic measurements in the dysphagia evaluation protocol in individuals with TL, most notably in those with symptomatic swallowing complaints.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:809-817, 2025.

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study

BACKGROUND

Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT).

OBJECTIVES

This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC.

METHODS

This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2 weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL).

RESULTS

Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL.

CONCLUSIONS

Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06301763.

Improvement in Swallowing Function in Patients with Previous Irradiation for Nasopharyngeal Carcinoma by Expiratory Muscle Strength Training

Dysphagia and chronic aspiration are common post-irradiation complications in nasopharyngeal carcinoma (NPC) survivors. Expiratory Muscle Strength Training (EMST) is a simple device-driven exercise therapy for swallowing training. This study investigates the effectiveness of EMST in a group of post-irradiated NPC patients. This prospective cohort, including twelve patients with previous irradiation for NPC and with swallowing disturbance, was performed between 2019 and 2021 in a single institution. Patients were trained with EMST for 8 weeks. Non-parametric analyses examined effects of EMST on primary outcome, maximum expiratory pressure. Secondary outcomes were measured with Penetration-aspiration scale, Yale pharyngeal residue severity rating scale (YPRSRS) by flexible endoscopic evaluation of swallowing, and Eating Assessment Tool (EAT-10) and M.D. Anderson Dysphagia Inventory questionnaire. Twelve patients, with a mean (SD) age of 64.3 (8.2) were recruited. There was no patient dropout with 88.9% overall compliance of training. Maximum expiratory pressure improved by 41% (median 94.5 to 133.5 cmH2O, p = 0.003). There was reduction in Penetration-aspiration scale with thin liquid (median 4 to 3, p = 0.026), and in YPRSRS at pyriform fossa with mildly thick liquid (p = 0.021) and at vallecula with thin liquid (p = 0.034), mildly thick liquid (p = 0.014) and pureed meat congee (p = 0.016). Questionnaire scores did not significantly change statistically. EMST is an easy-to-use and effective exercise therapy to improve airway safety and swallowing function in post-irradiated NPC survivors.

Predictive Factors for Chemoradiation-Induced Oral Mucositis and Dysphagia in Head and Neck Cancer: A Scoping Review

Despite advances in head and neck cancer treatment, virtually all patients experience chemoradiation-induced toxicities. Oral mucositis (OM) and dysphagia are among the most prevalent and have a systemic impact on patients, hampering treatment outcome and harming quality of life. Accurate prediction of severe cases is crucial for improving management strategies and, ultimately, patient outcomes. This scoping review comprehensively maps the reported predictors and critically evaluates the performance, methodology, and reporting of predictive models for these conditions. A total of 174 studies were identified from database searches, with 73 reporting OM predictors, 97 reporting dysphagia predictors, and 4 reporting both OM and dysphagia predictors. These predictors included patient demographics, tumor classification, chemoradiotherapy regimen, radiation dose to organs-at-risk, genetic factors, and results of clinical laboratory tests. Notably, many studies only conducted univariate analysis or focused exclusively on certain predictor types. Among the included studies, numerous predictive models were reported: eight for acute OM, five for acute dysphagia, and nine for late dysphagia. The area under the receiver operating characteristic curve (AUC) ranged between 0.65 and 0.81, 0.60 and 0.82, and 0.70 and 0.85 for acute oral mucositis, acute dysphagia, and late dysphagia predictive models, respectively. Several areas for improvement were identified, including the need for external validation with sufficiently large sample sizes, further standardization of predictor and outcome definitions, and more comprehensive reporting to facilitate reproducibility.

Effects of Swallowing Rehabilitation Training with a Balloon Dilation Therapy on the Deglutition Function and Quality of Life of Patients with Dysphagia after Radiotherapy for Nasopharyngeal Carcinoma

Objective

The aim of this study is to investigate the effects of swallowing rehabilitation training with a balloon dilation therapy on the deglutition function and quality of life of patients with dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC).

Methods

The study was a retrospective study. The data of the 100 patients with dysphagia after NPC radiotherapy in our hospital between April 2021 and April 2022 were retrospectively analyzed. The patients were separated into the control group (n = 50) and experimental group (n = 50) according to their different treatments that were balloon dilation for the former and balloon dilation with swallowing rehabilitation training for the latter. The deglutition function, which was comprehensively evaluated by Kubota's water swallow test and assessments of penetration/aspiration and pharyngeal residue, and quality of life were compared between the two groups.

Results

The scores of Kubota's water swallow test, penetration aspiration scale (PAS), and Yale pharyngeal residue severity rating scale (YPR-SRS) in the experimental group after treatment were (2.04 ± 0.66), (2.92 ± 1.07), and (2.42 ± 0.90), respectively, which were remarkably lower than (2.58 ± 0.78), (4.38 ± 1.51), and (2.78 ± 0.86) in the control group, with distinct differences in the data between both the groups (P < 0.05). The quality of life of patients in the experimental group was distinctly better than that in the control group (P < 0.001).

Conclusion

Swallowing rehabilitation training in combination with a balloon dilation therapy can improve the deglutition function in patients with dysphagia after NPC radiotherapy as well as their quality of life, with a clinical application value.

Effects of Self-Care plus Forecasting Nursing on the Treatment Outcomes and Emotions in Patients with Nasopharyngeal Carcinoma after Radiotherapy

Objective

To explore the effects of self-care plus forecasting nursing on the treatment outcomes and emotions in nasopharyngeal carcinoma patients undergoing radiotherapy.

Methods

Eighty nasopharyngeal carcinoma patients after radiotherapy admitted to our hospital from February 2020 to August 2021 were selected. The patients were allocated into an observation group (n = 40) and an experimental group (n = 40) according to different nursing protocols. The observation group received traditional nursing intervention, whereas the experimental group received self-care plus forecasting nursing intervention. The levels of the indexes (quality of life, score on the Zung Self-Rating Anxiety Scale (SAS), score on the Zung Self-Rating Depression Scale (SDS), and adverse reaction) were compared between the two groups.

Results

The score of the experimental group for the quality of life was significantly higher than that of the observation group (P < 0.05); the SAS and SDS scores of the experimental group after nursing intervention were significantly lower than those of the observation group (P < 0.05); the incidence of adverse reactions in the experimental group during radiotherapy was significantly lower than that of the observation group (P < 0.05).

Conclusion

The self-care plus forecasting nursing intervention is effective in postradiotherapy patients with nasopharyngeal carcinoma. The technique is proved effective to improve the quality of life, reduce anxiety and depression, and decrease the incidence of adverse reactions in patients during treatment. These features make the technique worthy of a wider clinical application.