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Swallowing dysfunction—preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: A critical review

2003; Elsevier BV; Volume: 57; Issue: 5 Linguagem: Inglês

10.1016/s0360-3016(03)01454-8

1879-355X

Bharat B. Mittal, Barbara Roa Pauloski, Daniel J. Haraf, Harold J. Pelzer, Athanassios Argiris, Everett E. Vokes, Alfred Rademaker, Jerilyn A. Logemann,

Dysphagia Assessment and Management

Traditionally, surgery and/or radiotherapy (RT) alone has been used to treat head-and-neck cancer. During the past decade, various RT fractionation schedules or a combination of RT and chemotherapy have been used to increase tumor control and maintain organ anatomy ( 1 The Department of Veterans Affairs Laryngeal Cancer Study GroupInduction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991; 324: 1685-1690 Crossref PubMed Scopus (2223) Google Scholar , 2 Lefebvre J.L. Chavalier D. Lubonski B. Larynx preservation in pyriform sinus cancer Preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. J Natl Cancer Inst. 1996; 88: 890-899 Crossref PubMed Scopus (1137) Google Scholar , 3 Kies M.S. Haraf D.J. Athanasiadis I. et al. Induction chemotherapy followed by concurrent chemoradiation for advanced head and neck cancer Improved disease control and survival. J Clin Oncol. 1998; 16: 2715-2721 PubMed Google Scholar , 4 Lefebvre J.L. Organ preservation Where do we stand?. Acta Otorhinol Belg. 1999; 53: 223-225 PubMed Google Scholar , 5 Haraf D.J. Kies M. Rademaker A.W. et al. Radiation therapy with concomitant hydroxyurea and fluorouracil in stage II and III head and neck cancer. J Clin Oncol. 1999; 17: 638-644 Crossref PubMed Google Scholar , 6 Vokes E.E. Kies M.S. Haraf D.J. et al. Concomitant chemoradiotherapy as primary therapy for locoregionally advanced head and neck cancer. J Clin Oncol. 2000; 18: 1652-1661 PubMed Google Scholar , 7 Fu K.K. Pajak T.F. Trotti A. et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation to standard fractionation radiotherapy for head-and-neck squamous cell carcinoma First report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000; 48: 7-16 Abstract Full Text Full Text PDF PubMed Scopus (1106) Google Scholar , 8 Olmi P. Crispino S. Fallai C. et al. Locoregionally advanced carcinoma of the oropharynx Conventional radiotherapy vs accelerated hyperfractionated radiotherapy vs concomitant radiotherapy and chemotherapy: A multicenter randomized trial. Int J Radiat Oncol Biol Phys. 2003; 55: 78-92 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar ). However, the preservation of anatomy does not necessarily translate into the preservation of organ function. It is essential to document the functional status of an organ objectively to assess the true benefit of organ-preservation protocols. Swallowing dysfunctions, one of the major toxicities ( 9 Ko J.Y. Hsieh T. Investigation of life quality in nasopharyngeal carcinoma patients with long-term survival after radiotherapy. J Otolaryngol Soc Roc. 1988; 23: 181-190 Google Scholar , 10 Mittal B.B. Kepka A. Mahadevan A. et al. Tissue-dose compensation to reduce toxicity from combined radiation and chemotherapy for advanced head and neck cancers. Int J Cancer (Radiat Oncol Invest). 2001; 96: 61-70 Crossref Scopus (24) Google Scholar ) observed after treatment of head-and-neck cancer, adversely impacts patients' quality of life ( 11 List M.A. Mumby P. Haraf D. et al. Performance and quality of life outcome in patients completing concomitant chemoradiotherapy for head and neck cancers. Qual Life Res. 1997; 6: 274-284 Crossref PubMed Google Scholar , 12 List M.A. Siston A. Haraf D. et al. Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy A prospective examination. J Clin Oncol. 1999; 17: 1020-1028 PubMed Google Scholar ). These swallowing changes must be assessed carefully to define the abnormalities and institute appropriate management and therapy. The RT literature has a paucity of objective data on swallowing disorders after treatment of head-and-neck cancers ( 13 Eisbruch A. Lyden T. Bradford C.R. et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2002; 53: 23-28 Abstract Full Text Full Text PDF PubMed Scopus (371) Google Scholar ). For the past two decades, Northwestern University's Department of Communication Sciences and Disorders has been working to understand the nature of the anatomic and physiologic changes in swallowing after the treatment of head-and-neck cancer, with the goal of devising effective preventative and rehabilitation strategies for these patients ( 10 Mittal B.B. Kepka A. Mahadevan A. et al. Tissue-dose compensation to reduce toxicity from combined radiation and chemotherapy for advanced head and neck cancers. Int J Cancer (Radiat Oncol Invest). 2001; 96: 61-70 Crossref Scopus (24) Google Scholar , 14 Fisher H. Logemann J.A. The Fisher-Logemann test of articulation competence. Houghton Mifflin, Boston1971 Google Scholar , 15 Logemann J.A. 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Head Neck. 1994; 16: 259-265 Crossref PubMed Scopus (29) Google Scholar , 26 Lazarus C.L. Logemann J.A. Pauloski B.R. et al. Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy. Laryngoscope. 1996; 106: 1157-1166 Crossref PubMed Scopus (228) Google Scholar , 27 Logemann J.A. Pauloski B.R. Rademaker A.W. et al. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997; 19: 535-540 Crossref PubMed Google Scholar , 28 McConnel F.M.S. Pauloski B.R. Logemann J.A. et al. The functional results of primary closure versus flaps in oropharyngeal reconstruction A prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg. 1998; 124: 625-630 Crossref PubMed Scopus (173) Google Scholar , 29 Pauloski B.R. Rademaker A.W. Logemann J.A. et al. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg. 1998; 118: 616-624 Crossref PubMed Scopus (160) Google Scholar , 30 Pauloski B.R. Logemann J.A. Impact of tongue-base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000; 22: 120-131 Crossref PubMed Scopus (50) Google Scholar , 31 Lazarus C. Logemann J.A. Shi G. et al. Does total laryngectomy improve swallowing after chemoradiotherapy. Arch Otolaryngol Head Neck Surg. 2002; 128: 54-57 Crossref PubMed Scopus (21) Google Scholar ). We discuss selected published data from our laboratory and review the relevant literature. We also review some of the preventative and rehabilitative methods used to reduce the negative effects of surgery, RT, and chemotherapy on patients with swallowing disorders.