Pharyngeal transport dysfunction consequent to an organ-sparing protocol

Objective: To investigate the effects of a protocol of concomitant intraven ous hydroxyurea and hyperfractionated, accelerated, external-beam radiation therapy on the swallowing mechanism of patients with advanced-stage head a nd neck cancer. Design: Posttreatment videofluoroscopic swallow function studies, using ima ges of single-bolus swallows of low-density liquid barium, were analyzed in real time, slow motion, and frame by frame using an integrated system that allows objective analysis of video recordings through image processing and digitization (Kay Elemetrics Computerized Swallowing Station). Radiologica l descriptors were used for pharyngeal transport abnormalities, and tempora l measures were obtained of structural movements. Setting: Academic, tertiary care, referral medical center. Patients: Fifteen consecutive patients with previously untreated, stages II I and IV, nonmetastatic squamous cell carcinoma of the head and neck who un derwent a phase I study of prolonged infusion hydroxyurea therapy in combin ation with hyperfractionated, accelerated external-beam radiation therapy f or their disease. Results: All patients had anterior pharyngeal seg;ment dysfunction, charact erized by no epiglottic movement and slowed laryngeal motility (1.011 +/- 0 .379 seconds [mean +/- SD]). Anterior pharyngeal dysfunction was more sever e in patients with primary tumors of the hypopharynx than in those with can cer of the oropharynx. Twelve (80%) of our patients demonstrated posterior pharyngeal segment dysfunction characterized by impaired pharyngeal constri ctor motility. All IS patients displayed pharyngeal stage abnormalities tha t limited bolus transport and clearance. Conclusions: Severe pharyngeal physiological abnormalities were present tha t led to impaired bolus transport and that were frequent and debilitating c onsequences of this organ-sparing protocol. Long-term follow-up of this gro up will be required to assess the permanence of the abnormalities.