Results of pretreatment swallowing evaluation in patients with stage III/IV laryngeal and hypopharyngeal carcinoma
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HEAD AND NECK
Results of pretreatment swallowing evaluation in patients with stage III/IV laryngeal and hypopharyngeal carcinoma Arun Balaji1 · Shivakumar Thiagarajan2 · Akshat Mallik3 · Nandini Menon2 · Adhara Chakraborthy2 · Devendra Chaukar2 Received: 12 August 2020 / Accepted: 27 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Laryngeal and hypopharyngeal carcinoma are among the common head and neck cancers causing considerable swallowing dysfunction. The functional status of the organ (larynx) is an important point of contention while considering the patients for organ preservation protocol. Methodology The aim of this retrospective study was to assess the swallowing status in stage III/IV laryngeal and hypopharyngeal carcinoma and its influence on treatment decision. We evaluated all treatment naïve patients who were referred to the swallowing clinic in 2017 (Jan–Dec) for assessment of swallowing prior to treatment initiation. Results One hundred patients satisfied the eligibility criteria and were included in the study. The site and stage of laryngeal and hypopharyngeal cancer cases were almost equal in number. Their median age was 58 years. Fiberoptic endoscopic evaluation of swallowing (FEES) was done in all patients. 30% of the patients only had swallowing difficulties. Only advanced T-stage (p = 0.04) had an influence on the pretreatment swallowing status. Thirty-seven patients required nasogastric tube (NGT) for feeding. By 2 month post-treatment completion, most patients on NGT could resume oral feeding. Conclusions Pretreatment swallowing assessment alone did not significantly seem to influence our decisions for organ preservation treatment. However, patients with aspiration could be identified and managed appropriately. Most patients on NGT could resume oral feeds post-treatment completion. Keywords Pretreatment swallowing · Assessment · FEES · Deglutition
Introduction Patients with laryngeal and hypopharyngeal cancer may have varying degree of swallowing difficulties [1]. Laryngeal and hypopharyngeal cancers have been reported to have a higher degree of pretreatment swallowing dysfunction in comparison with other head and neck cancers [2]. Identifying these swallowing difficulties is essential to introduce appropriate intervention, in the form of dietary * Shivakumar Thiagarajan [email protected] 1
Division of Speech & Swallowing Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
2
Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra 400012, India
3
Department of ENT, Chairing Cross Hospital, London, UK
modifications, swallowing maneuver and also to select an appropriate treatment strategy for the patient. Several institutes now routinely perform pretreatment swallowing assessment to identify swallowing dysfunction [3]. Swallowing difficulties can also be present as post-treatment sequelae in these patien
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