Dysphagia after Chemoradiation: Analysis by Modified Barium Swallow

• Published in: Annals of otology, rhinology & laryngology rhinology & laryngology, 2007-11, Vol.116 (11), p.837-841
• Main Authors: Bleier, Benjamin S., Levine, Marc S., Mick, Rosemarie, Rubesin, Stephen E., Sack, Stephen Z., McKinney, Kibwei, Mirza, Natasha
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Barium Sulfate - administration & dosage; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - therapy; Contrast Media - administration & dosage; Deglutition - drug effects; Deglutition - radiation effects; Deglutition Disorders - diagnostic imaging; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Esophagus; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Medical sciences; Middle Aged; Oropharyngeal Neoplasms - drug therapy; Oropharyngeal Neoplasms - radiotherapy; Oropharyngeal Neoplasms - therapy; Other diseases. Semiology; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Prognosis; Radiography; Radiotherapy, Adjuvant - adverse effects; Retrospective Studies; Tumors
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348940711601108

Objectives: We sought to describe the findings of modified barium swallow study after chemoradiation in patients with head and neck cancer and to correlate these findings with clinical variables, including gastrostomy tube dependence and clinical pneumonia. Methods: We retrospectively reviewed 49 patients at a tertiary care center who underwent modified barium swallow study for dysphagia after chemoradiation. Results: Patients with nonlaryngeal lesions had increased cricopharyngeal impairment (27.8% versus 0.0%; p = .04). Patients who underwent concomitant chemotherapy had increased epiglottic changes relative to those who had radiotherapy alone (66.7% versus 30.8%; p = .05). Clinical pneumonia developed in 31.9% of the patients, and 79.6% required gastrostomy tube placement for a mean duration of 18.1 months. Conclusions: Chemoradiation effects deglutition at multiple levels. A large percentage of patients will develop pneumonia and feeding tube dependence. This study is among the largest to correlate the results of modified barium swallow studies to clinical variables in this patient population. This study highlights the significant incidence of gastrostomy tube dependence and pneumonia in these patients.