PurposeDysphagia is one of the most debilitating chronic symptoms experienced by patients who undergo radiation treatment for head and neck cancer. Despite the high prevalence of dysphagia in patients with head and neck cancer, we lack understanding of the specific changes in swallowing physiology that arise in the short-term following radiation therapy and how these changes impact the key functions of swallowing safety and efficiency. This study sought to identify pathophysiological mechanisms underlying impairments in swallowing safety and efficiency on thin liquids following (chemo)radiation for oropharyngeal cancer.MethodVideofluoroscopic swallowing studies were completed in 12 male patients within 6 months following completion of (chemo)radiation and in 12 healthy male controls. To compare swallowing function and physiology between groups, we analyzed three discrete sips of 20% w/v thin liquid barium per participant. The videofluoroscopic swallowing study recordings were rated for swallowing safety, efficiency, timing parameters, and pixel-based measures of structural area or movement.ResultsThe oropharyngeal cancer cohort displayed significantly higher frequencies of penetration–aspiration, incomplete laryngeal vestibule closure, prolonged time-to-laryngeal vestibule closure, and poor pharyngeal constriction. Incomplete or delayed laryngeal vestibule closure was associated with airway invasion, while poor pharyngeal constriction was associated with pharyngeal residue.ConclusionsThis study highlights the primary mechanisms behind impaired safety and efficiency of the swallow in patients following (chemo)radiation for oropharyngeal cancer.

中文翻译：

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口咽癌放射治疗后稀薄液体吞咽障碍的机制

目的吞咽困难是接受头颈癌放射治疗的患者所经历的最令人衰弱的慢性症状之一。尽管头颈癌患者吞咽困难的患病率很高，但我们对放射治疗后短期内吞咽生理学的具体变化以及这些变化如何影响吞咽安全性和效率的关键功能缺乏了解。本研究旨在确定口咽癌（化学）辐射后吞咽稀液体的安全性和效率受损的病理生理机制。方法在完成（化疗）放疗后 6 个月内，对 12 名男性患者和 12 名健康男性对照者完成了电视荧光镜吞咽研究。为了比较各组之间的吞咽功能和生理机能，我们分析了每位参与者三口不连续的 20% w/v 稀液体钡。视频透视吞咽研究记录的吞咽安全性、效率、时间参数以及基于像素的结构区域或运动测量进行了评级。结果口咽癌队列表现出明显较高的刺穿-误吸频率、喉前庭闭合不完全、喉前庭闭合时间延长和咽部收缩不良。喉前庭闭合不完全或延迟与气道侵入有关，而咽部收缩不良与咽部残留物有关。结论这项研究强调了口咽癌患者接受（化学）放射治疗后吞咽安全性和效率受损的主要机制。