Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea - Initial results

Objective: To evaluate the long-term effects on swallowing function of conc omitant continuous infusion hydroxyurea and hyperfractionated radiation the rapy used to treat advanced head and neck carcinoma. Design: A prospective evaluation of swallowing function was performed on an inception cohort by analyzing posttreatment videoflouroscopic swallow func tion studies using radiological descriptors for pharyngeal transport abnorm alities and temporal measures of structural movements, as well as by conduc ting patient interviews to assess alimentation, more than 1 year after tumo r treatment (range, 52-124 weeks; median, 70 weeks). Setting: Academic tertiary care referral medical center. Patients: Ten patients, aged 44 to 71 years, with stage III and IV squamous cell carcinoma of the oral cavity, oropharynx, or hypopharynx. Main Outcome Measure: Radiographic and temporal swallow abnormalities, as w ell as functional status, were documented and compared with published norms and results of earlier swallowing studies when possible. Results: Pharyngeal transport dysfunction and anterior segment abnormalitie s, manifested by epiglottic dysmotility, vallecular residue, laryngeal pene tration, or aspiration, were evident in all 10 patients. Posterior segment abnormalities, such as pharyngeal stasis, constrictor dysmotility and pirif orm residue were documented in 8 patients. Three patients developed late as piration, and the majority of patients showed persistent or worsened delay in laryngeal movement compared with their earlier posttreatment evaluations . Also, 3 patients developed a hypopharyngeal stricture, and 6 patients con tinued to require gastrostomy tube supplementation beyond 1 year. There was no association between site of primary, duration to swallowing evaluation, and severity of dysfunction. Conclusion: Prolonged and debilitating functional swallowing abnormalities may occur after this aggressive concomitant chemotherapy and radiotherapy r egimen.