SWALLOW RECOVERY IN AN ORAL-CANCER PATIENT FOLLOWING SURGERY, RADIOTHERAPY, AND HYPERTHERMIA

Background. No study has examined the nature and extent of swallowing impairment in oral cancer patients following treatment with combined h yperthermia and interstitial radiotherapy. Few studies have examined t he effects of voluntary swallow maneuvers (supersupraglottic and Mende lsohn) on pharyngeal phase swallowing in the oral cancer patient treat ed with surgery or radiotherapy. This study examined the effects of co mbined radiotherapeutic salvage treatments of hyperthermia and interst itial implantation and swallow recovery using swallow maneuvers in a s urgically treated and irradiated oral cancer patient. Methods. The pat ient understudy, a 51-year-old man, underwent radiotherapy, according to Radiation Therapy Oncology Group (RTOG) protocol #8419, consisting of a combination of interstitial irradiation and hyperthermia to the b ase of tongue, for a recurrent squamous cell cancer. He underwent vide ofluorographic (VFG) examination of his swallowing, a modified barium swallow at three time points: 2 days following radiotherapy treatment (VFG1), 4 weeks later (VFG2), and 8 months later (VFG3). Temporal and biomechanical analyses of swallows were performed at each time point. Results. Swallow maneuvers and time resulted in improved laryngeal ele vation and laryngeal vestibule closure during the swallows on VFG2. Ma ximum upper esophageal sphincter (UES) opening width and duration were more normal. Fewer swallows were required for bolus clearance through the pharynx. Base of tongue tissue necrosis occurred as a complicatio n of radiotherapy between VFG2 and VFG3, with resultant severe reducti on in posterior movement of the tongue base, incomplete tongue base co ntact to the posterior pharyngeal wall, reduced laryngeal elevation, a nd incomplete laryngeal vestibule closure during swallowing at VFG3. U ES opening became less normal and a greater number of swallows were re quired tor bolus clearance through the pharynx. Conclusions. Combined interstitial irradiation and hyperthermia can cause oropharyngeal swal lowing problems. Time and swallow therapy can improve these swallow di sorders. Tongue base tissue necrosis can cause further swallow impairm ent, emphasizing the importance of the tongue base in normal deglutiti on. Further studies are needed to examine the impact of combined hyper thermia and interstitial implantation for treatment of tongue base tum ors on swallow functioning in a larger group of patients. (C) 1994 Joh n Wiley & Sons, Inc.