Swallowing dysfunction after head-and-neck irradiation – Is it worth the fiberoptic endoscopic evaluation of swallowing?

Background: Treatment-related swallowing dysfunction still represents a significant clinical issue affecting the quality of life of head and neck cancer (HNC) patients following radiation therapy (RT) or chemoradiation therapy (CRT). Aim: The aim of the study was to evaluate the incidence of swallowing dysfunction following RT or CRT by fiberoptic endoscopic evaluation of swallowing (FEES) and to analyze the FEES findings in reference to patient-, tumor- and treatment-related factors. Materials and Methods: This prospective study included histopathological-proven HNC patients undergoing objective swallowing assessment by FEES at baseline, 3 months, and 6 months after receiving RT or CRT from December 2013 to November 2014. The parameters used to represent swallowing dysfunction included pooling of secretions, laryngeal penetration, aspiration, laryngopharynx reflux, and nasopharyngeal reflux. Results: A total of 34 patients undergoing a swallowing assessment schedule were analyzed. At 3-month assessment, we found swallowing dysfunction in 38.2% of cases which was more frequent in patients with oral cavity and hypopharyngeal primaries than other primary sites of HNC (P = 0.013). There was a higher chance of swallowing dysfunction among locally advanced HNC patients than early-staged patients, particularly at 3-month assessment although statistically insignificant (41.3% vs. 20%). The most frequently noted swallowing dysfunction was pooling of secretions in the vallecula and pyriform fossa. At 3 months following RT/CRT, there was an increase in the incidence of swallowing dysfunction (38.2% of patients) which subsequently decreased by 6 months (20.6% of patients). Conclusions: It is imperative to pick up the observations pointing toward the development of future swallowing dysfunction among HNC patients following RT/CRT by performing FEES, thereby reducing mortality associated with silent aspiration.