SWALLOWING DISORDERS IN HEAD AND NECK-CANCER PATIENTS TREATED WITH RADIOTHERAPY AND ADJUVANT CHEMOTHERAPY

The nature of swallowing problems was examined in nine patients treate d primarily with external-beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent v ideofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorder s, residue, and aspiration; temporal analyses; and biomechanical analy ses, Oropharyngeal swallow efficiency was calculated for the first swa llow of each bolus. Swallow motility disorders were observed in both t he oral and pharyngeal stages. Seven of the nine patients demonstrated reduced posterior tongue base movement toward the posterior pharyngea l wall and reduced laryngeal elevation during the swallow. Oropharynge al swallow efficiency measures were significantly lower in the nine ir radiated patients than in age-matched normal subjects. Between patient s and normal subjects, significant differences were found in the measu res of timing and distance of pharyngeal structural movements during t he swallow, as well as in the measures of coordination during the swal low. Although treatment of head and neck cancer with external-beam rad iation is designed to provide cancer cure and preserve organ functioni ng, oral and pharyngeal motility for swallow can become compromised if external-beam radiation treatment is provided to either the larynx or tongue base regions.