Yonsei Med J.  2015 Sep;56(5):1221-1226. 10.3349/ymj.2015.56.5.1221.

Analysis of Dysphagia Patterns Using a Modified Barium Swallowing Test Following Treatment of Head and Neck Cancer

• Lee SY
• Kim BH
• Park YH

• KMID: 2163612
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1221

Abstract

PURPOSE
The purposes of this study were to evaluate specific dysphagia patterns and to identify the factors affecting dysphagia, especially aspiration, following treatment of head and neck cancer.
MATERIALS AND METHODS
A retrospective analysis of 57 patients was performed. Dysphagia was evaluated using a modified barium swallow (MBS) test. The MBS results were rated on the 8-point penetration-aspiration scale (PAS) and swallowing performance status (SPS) score.
RESULTS
Reduced base of the tongue (BOT) retraction (64.9%), reduced laryngeal elevation (57.9%), and cricopharyngeus (CP) dysfunction (47.4%) were found. Reduced BOT retraction was correlated with clinical stage (p=0.011) and treatment modality (p=0.001). Aspiration in 42.1% and penetration in 33.3% of patients were observed. Twenty-four patients had PAS values over 6, implying aspiration. Forty-one patients had a SPS score of more than 3, 25 patients had a score greater than 5, and 13 patients had a SPS score of more than 7. Aspiration was found more often in patients with penetration (p=0.002) and in older patients (p=0.026). In older patients, abnormal swallowing caused aspiration even in those with a SPS score of more than 3, irrespective of stage or treatment, contrary to younger patients. Tube feeders (n=20) exhibited older age (65.0%), dysphagia/aspiration related structures (DARS) primaries (75.0%), higher stage disease (66.7%), and a history of radiotherapy (68.8%).
CONCLUSION
Reduced BOT retraction was the most common dysphagia pattern and was correlated with clinical stage and treatment regimens including radiotherapy. Aspiration was more frequent in patients who had penetration and in older patients. In contrast to younger patients, older patients showed greater risk of aspiration even with a single abnormal swallowing irrespective of stage or treatment.

Keyword

Head and neck cancer; dysphagia; modified barium swallow; radiotherapy; aspiration

MeSH Terms

Adult
Aged
Aged, 80 and over
*Barium Sulfate
Combined Modality Therapy
Contrast Media
Deglutition
*Deglutition Disorders/diagnosis/etiology/physiopathology
Enteral Nutrition
Female
Head and Neck Neoplasms/complications/*radiotherapy
Humans
Male
Middle Aged
*Respiratory Aspiration/diagnosis/etiology/physiopathology
Retrospective Studies
Barium Sulfate
Contrast Media

Figure

• 

  Fig. 1 Penetration-aspiration scale (PAS) and swallowing performance score (SPS) determined via MBS. Twenty-four (42%) patients had a PAS score over 6, implying aspiration. Patients with a SPS score over 5 are at risk of aspiration and those with a score of 7 absolutely require primary tube feeding. Twenty-five (43.9%) patients had a score over 5 and 13 patients had a score of 7. MBS, modified barium swallow.

Reference

1. Nguyen NP, Moltz CC, Frank C, Karlsson U, Nguyen PD, Vos P, et al. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer. Eur J Radiol. 2006; 59:453–459.

2. Langerman A, Maccracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM. Aspiration in chemoradiated patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2007; 133:1289–1295.

3. Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004; 60:1425–1439.

4. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996; 11:93–98.

5. Logemann JA. Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg. 1997; 116:335–338.

6. Garden AS, Lewin JS, Chambers MS. How to reduce radiation-related toxicity in patients with cancer of the head and neck. Curr Oncol Rep. 2006; 8:140–145.

7. Logemann JA, Rademaker AW, Pauloski BR, Ohmae Y, Kahrilas PJ. Normal swallowing physiology as viewed by videofluoroscopy and videoendoscopy. Folia Phoniatr Logop. 1998; 50:311–319.

8. Francis DO, Weymuller EA Jr, Parvathaneni U, Merati AL, Yueh B. Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter? Ann Otol Rhinol Laryngol. 2010; 119:391–397.

9. Laurell G, Kraepelien T, Mavroidis P, Lind BK, Fernberg JO, Beckman M, et al. Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer. 2003; 97:1693–1700.

10. The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991; 324:1685–1690.

11. Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, et al. Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys. 2008; 70:330–337.

12. Dysphagia Section, Oral Care Study Group, Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, Gibson RJ, Eilers JG, et al. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012; 20:433–443.

13. Pauloski BR, Rademaker AW, Logemann JA, Newman L, Mac-Cracken E, Gaziano J, et al. Relationship between swallow motility disorders on videofluorography and oral intake in patients treated for head and neck cancer with radiotherapy with or without chemotherapy. Head Neck. 2006; 28:1069–1076.

14. Platteaux N, Dirix P, Dejaeger E, Nuyts S. Dysphagia in head and neck cancer patients treated with chemoradiotherapy. Dysphagia. 2010; 25:139–152.

15. Langmore SE, Grillone G, Elackattu A, Walsh M. Disorders of swallowing: palliative care. Otolaryngol Clin North Am. 2009; 42:87–105.

16. Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol. 2006; 80:302–306.

17. Murphy BA. Clinical and economic consequences of mucositis induced by chemotherapy and/or radiation therapy. J Support Oncol. 2007; 5:9 Suppl 4. 13–21.

18. Butler SG, Stuart A, Leng X, Rees C, Williamson J, Kritchevsky SB. Factors influencing aspiration during swallowing in healthy older adults. Laryngoscope. 2010; 120:2147–2152.

19. Kurosu A, Logemann JA. Gender effects on airway closure in normal subjects. Dysphagia. 2010; 25:284–290.

20. Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, et al. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006; 28:64–73.

21. Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J. Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg. 2005; 131:762–770.