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Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy

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Abstract

Intensity-modulated radiotherapy (IMRT) is a treatment method that is used in the treatment of head and neck cancers. Impairment of chewing and swallowing functions in the early and late periods of radiotherapy is frequent. Therefore, revealing the dose–effect relationship is important. The main purpose of this study is to investigate the dose–effect relationship between chewing and swallowing structures objectively via a standardized videofluoroscopy protocol. The study included 35 participants treated with chemo-IMRT. A videofluoroscopic swallowing study (VFSS) was performed before IMRT, and 3 and 6 months after IMRT. VFSS results were scored according to the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Maximum interincisor mouth opening, body mass index (BMI), and Functional Oral Intake Scale levels were determined in these cases. The quality of life of participants was evaluated. There was a significant increase in PAS and MBSImP scores and a significant decrease in BMI scores of the patients after treatment. Xerotomy and sticky saliva complaints increased after treatment. The dose to the mastication muscles (> 40 Gy) and the temporomandibular joint (> 46 Gy) were found to be associated with a decrease in BMI; the dose to the superior pharyngeal constructor muscle (> 58 Gy) was found to be associated with pharyngeal stripping wave. The presence of aspiration was associated with the inferior pharyngeal constructor muscle, glottic larynx, supraglottic larynx, and upper esophageal sphincter. Important findings to emerge from this study include detected toxic dose limits. These findings may guide physicians to minimize the side effects of IMRT.

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Acknowledgements

The authors would like to thank Yonca Berk-Giray, MS, CCC-SLP, for her assistance with a blind interpretation of VFSS.

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Authors and Affiliations

  1. Department of Speech and Language Therapy, Faculty of Health Sciences, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey

    Aydan Baştuğ Dumbak, Fatma Esen Aydınlı, Önal İncebay & Maviş Emel Kulak Kayıkcı

  2. Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey

    Gözde Yazıcı & Zehra Yıldız

  3. Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey

    Deniz Yüce

  4. Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Sıhhiye, 06230, Ankara, Turkey

    Nilda Süslü & Oğuz Kuşçu

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  1. Aydan Baştuğ Dumbak
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Appendix

Appendix

Appendix 1 Distribution of the mean radiation dose of the cases
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Appendix 2 Change in chewing and swallowing functions overtime
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Appendix 3 Change in quality of life overtime
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Baştuğ Dumbak, A., Esen Aydınlı, F., Yazıcı, G. et al. Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy. Dysphagia 37, 1400–1413 (2022). https://doi.org/10.1007/s00455-021-10398-x

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