T Kotz1, S Abraham, J J Beitler, S Wadler, R V Smith. 1. Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center and the Albert Einstein Cancer Center, Bronx, NY 10467, USA.
Abstract
OBJECTIVE: To investigate the effects of a protocol of concomitant intravenous hydroxyurea and hyperfractionated, accelerated, external-beam radiation therapy on the swallowing mechanism of patients with advanced-stage head and neck cancer. DESIGN: Posttreatment videofluoroscopic swallow function studies, using images of single-bolus swallows of low-density liquid barium, were analyzed in real time, slow motion, and frame by frame using an integrated system that allows objective analysis of video recordings through image processing and digitization (Kay Elemetrics Computerized Swallowing Station). Radiological descriptors were used for pharyngeal transport abnormalities, and temporal measures were obtained of structural movements. SETTING: Academic, tertiary care, referral medical center. PATIENTS: Fifteen consecutive patients with previously untreated, stages III and IV, nonmetastatic squamous cell carcinoma of the head and neck who underwent a phase 1 study of prolonged infusion hydroxyurea therapy in combination with hyperfractionated, accelerated external-beam radiation therapy for their disease. RESULTS: All patients had anterior pharyngeal segment dysfunction, characterized by no epiglottic movement and slowed laryngeal motility (1.011 +/- 0.379 seconds [mean +/- SD). Anterior pharyngeal dysfunction was more severe in patients with primary tumors of the hypopharynx than in those with cancer of the oropharynx. Twelve (80%) of our patients demonstrated posterior pharyngeal segment dysfunction characterized by impaired pharyngeal constrictor motility. All 15 patients displayed pharyngeal stage abnormalities that limited bolus transport and clearance. CONCLUSIONS: Severe pharyngeal physiological abnormalities were present that led to impaired bolus transport and that were frequent and debilitating consequences of this organ-sparing protocol. Long-term follow-up of this group will be required to assess the permanence of the abnormalities.
OBJECTIVE: To investigate the effects of a protocol of concomitant intravenous hydroxyurea and hyperfractionated, accelerated, external-beam radiation therapy on the swallowing mechanism of patients with advanced-stage head and neck cancer. DESIGN: Posttreatment videofluoroscopic swallow function studies, using images of single-bolus swallows of low-density liquid barium, were analyzed in real time, slow motion, and frame by frame using an integrated system that allows objective analysis of video recordings through image processing and digitization (Kay Elemetrics Computerized Swallowing Station). Radiological descriptors were used for pharyngeal transport abnormalities, and temporal measures were obtained of structural movements. SETTING: Academic, tertiary care, referral medical center. PATIENTS: Fifteen consecutive patients with previously untreated, stages III and IV, nonmetastatic squamous cell carcinoma of the head and neck who underwent a phase 1 study of prolonged infusion hydroxyurea therapy in combination with hyperfractionated, accelerated external-beam radiation therapy for their disease. RESULTS: All patients had anterior pharyngeal segment dysfunction, characterized by no epiglottic movement and slowed laryngeal motility (1.011 +/- 0.379 seconds [mean +/- SD). Anterior pharyngeal dysfunction was more severe in patients with primary tumors of the hypopharynx than in those with cancer of the oropharynx. Twelve (80%) of our patients demonstrated posterior pharyngeal segment dysfunction characterized by impaired pharyngeal constrictor motility. All 15 patients displayed pharyngeal stage abnormalities that limited bolus transport and clearance. CONCLUSIONS: Severe pharyngeal physiological abnormalities were present that led to impaired bolus transport and that were frequent and debilitating consequences of this organ-sparing protocol. Long-term follow-up of this group will be required to assess the permanence of the abnormalities.
Authors: Irene Jacobi; Arash Navran; Lisette van der Molen; Wilma D Heemsbergen; Frans J M Hilgers; Michiel W M van den Brekel Journal: Eur Arch Otorhinolaryngol Date: 2015-02-01 Impact factor: 2.503
Authors: Bharat B Mittal; Barbara Roa Pauloski; Alfred W Rademaker; Muveddet Discekici-Harris; Irene B Helenowski; Ann Mellot; Mark Agulnik; Jerilyn A Logemann Journal: Head Neck Date: 2014-04-09 Impact factor: 3.147
Authors: J Scott Magnuson; Jennifer Durst; Eben L Rosenthal; William R Carroll; Christine S Ritchie; Meredith L Kilgore; Julie L Locher Journal: Head Neck Date: 2012-04-14 Impact factor: 3.147
Authors: Barbara Roa Pauloski; Alfred W Rademaker; Jerilyn A Logemann; Muveddet Discekici-Harris; Bharat B Mittal Journal: Head Neck Date: 2014-08-01 Impact factor: 3.147
Authors: Lisette van der Molen; Maya A van Rossum; Lori M Burkhead; Ludi E Smeele; Frans J M Hilgers Journal: Eur Arch Otorhinolaryngol Date: 2008-09-30 Impact factor: 2.503
Authors: Martin B Brodsky; David H McFarland; Thomas S Dozier; Julie Blair; Christopher Ayers; Yvonne Michel; M Boyd Gillespie; Terry A Day; Bonnie Martin-Harris Journal: Head Neck Date: 2010-04 Impact factor: 3.147