Swallowing Function after Altered Fractionation Radiotherapy for Head and Neck Carcinoma

KH Yu, M Chua, AC Vlantis, MKM Kam, WY Lee, RKY Tsang, HY Yuen, EP Hui, ATC Chan

Hong Kong J Radiol 2005;8:207-13

Objective: To investigate swallowing function outcome in patients with head and neck cancer who received altered fractionation radiotherapy.

Patients and Methods: Forty nine patients with bulky T2 tumours or American Joint Committee on Cancer stage III/IV disease were treated with accelerated radiotherapy with concomitant boost to 72 Gy-80 Gy or hyperfractionated accelerated radiotherapy to 76.8 Gy. The pre- and post-radiotherapy swallowing dysfunction were scored with a physician-rated scale of grade 0 (normal) to 4 (severe impairment). The Wilcoxon signed rank test was used to compare pre- and post-radiotherapy scores in patients who did not have local failure or a second head and neck primary.

Results: At a median follow-up of 15.7 months (range, 3.7 to 66.0 months), 9 patients had developed permanent grade 3/4 swallowing dysfunction. This was associated with local failure in 8 patients. The 1-year actuarial permanent grade 3/4 swallowing dysfunction-free survival was 93% for the whole patient series. Of 26 patients (53%) who did not develop local failure or a second head and neck primary, the worst late swallowing dysfunction scores (mean, 0.81; median, 1) were significantly higher than the pre- radiotherapy scores (mean, 0.23; median, 0; p = 0.0016).

Conclusions: Permanent severe swallowing dysfunction was uncommon during early follow-up in local failure-free patients who received curative altered fractionation radiotherapy for locoregionally advanced head and neck carcinoma.