Late dysphagia after radiotherapy-based treatment of head and neck cancer.
Late dysphagia after radiotherapy-based treatment of head and neck cancer.
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头颈癌放射治疗后晚期吞咽困难。
DOI：
10.1002/cncr.27631
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发表时间：
2012-12-01
期刊：
影响因子：
6.2
通讯作者：
Holsinger, F. Christopher
中科院分区：
文献类型：
--
作者：
Hutcheson, Katherine A.;Lewin, Jan S.;Barringer, Denise A.;Lisec, Asher;Gunn, G. Brandon;Moore, Michael W. S.;Holsinger, F. Christopher
头颈癌(HNC)的变化趋势值得了解治疗的远期效应，但很少有研究检查超过2年治疗后的吞咽困难。对一系列病例进行检查，以描述确诊放疗或化疗后5年(2001年1月至2011年5月)的吞咽困难的HNC幸存者的病理生理和转归，这些幸存者被转介进行改良的吞钡试验(≥)。功能评定包括穿透吸入量表(PAS)、头颈部功能状态量表(PSS-HN)、吞咽安全量表(NIH-SSS)和MBSImp。29名以前接受放射治疗(38%)或化疗(62%)的患者被纳入(治疗后中位数：9年，范围：5-19年)。大多数人(86%)患有口咽癌；52%的人从不吸烟。75%的人患有T2-T3疾病；52%的人是N+。确诊时的中位年龄为55岁(范围：38-72岁)。晚期检查异常包括：构音障碍/发音困难(76%)、脑神经病变(48%)、三叉神经症(38%)和放射性坏死(10%)。MBS检查证实了所有因生理性损伤导致吞咽困难的病例(中位数PAS：8；中位数NIH-SSS：10；中位数MBSImp：18)，而7例(24%)经内窥镜证实为狭窄。25人(86%)患上肺炎，一半需要住院治疗。吞咽姿势/策略对69%的病例有帮助，但在最后一次随访中，没有患者在各项功能措施上取得持久的改善。最终19例(66%)依赖胃造口术。虽然功能性器官的保存是常见的，但严重的吞咽困难是一种具有挑战性的晚期效应，可能会在以放射为基础的治疗后数年发展或进展。这些数据表明，需要新的方法来最大限度地减少和更好地解决这种并发症，这种并发症通常是许多标准吞咽困难疗法难以治愈的。
Changing trends in head and neck cancer (HNC) merit an understanding of late effects of therapy, but few studies examine dysphagia beyond 2 years of treatment. A case series was examined to describe the pathophysiology and outcomes in dysphagic HNC survivors referred for modified barium swallow (MBS) studies ≥5 years after definitive radiotherapy or chemoradiotherapy (01/2001–05/2011). Functional measures included the Penetration-Aspiration Scale (PAS), Performance Status Scale-Head and Neck (PSS-HN), Swallowing Safety Scale (NIH-SSS), and MBSImp. Twenty-nine patients previously treated with radiotherapy (38%) or chemoradiotherapy (62%) were included (median years post-treatment: 9, range: 5–19). The majority (86%) had oropharyngeal cancer; 52% were never smokers. Seventy-five percent had T2-T3 disease; 52% were N+. Median age at diagnosis was 55 (range: 38–72). Abnormal late examination findings included: dysarthria/dysphonia (76%), cranial neuropathy (48%), trismus (38%), and radionecrosis (10%). MBS studies confirmed pharyngeal residue and aspiration in all dysphagic cases owing to physiologic impairment (median PAS: 8; median NIH-SSS: 10; median MBSImp: 18) whereas stricture was confirmed endoscopically in 7 (24%). Twenty-five (86%) developed pneumonia, half requiring hospitalization. Swallow postures/strategies helped 69% of cases, but no patient achieved durable improvement across functional measures at last follow-up. Ultimately 19 (66%) were gastrostomy dependent. Although functional organ preservation is commonly achieved, severe dysphagia represents a challenging late effect that may develop or progress years after radiation-based therapy for HNC. These data suggest that novel approaches are needed to minimize and better address this complication that is commonly refractory to many standard dysphagia therapies.
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影响因子：
2.6
作者：
Martin-Harris, Bonnie;Brodsky, Martin B.;Michel, Yvonne;Castell, Donald O.;Schleicher, Melanie;Sandidge, John;Maxwell, Rebekah;Blair, Julie
通讯作者：
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影响因子：
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作者：
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DOI：
10.1002/hed.21022
发表时间：
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影响因子：
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作者：
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作者：
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