Predictive clinical factors for penetration-aspiration in patients with nasopharyngeal carcinoma after radiotherapy

Lalu Aditya Haris Pratama; Achmad Chusnu Romdhoni; Sri Herawati

doi:10.53730/ijhs.v6nS8.12563

Authors

Lalu Aditya Haris Pratama Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Dr. Soetomo General Academic Hospital, Universitas Airlangga, East Java, Surabaya, Indonesia
Achmad Chusnu Romdhoni
romdhoni-a-c@fk.unair.ac.id
Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Dr. Soetomo General Academic Hospital, Universitas Airlangga, East Java, Surabaya, Indonesia
Sri Herawati Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Dr. Soetomo General Academic Hospital, Universitas Airlangga, East Java, Surabaya, Indonesia

Keywords:

nasopharyngeal carcinoma, radiotherapy, pharyngeal residue, penetration-aspiration, life expectancy

Abstract

Penetration-aspiration is the most serious complication in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Radiotherapy has been shown to increase the patient's survival rate and life expectancy but it showed serious side effects such as oropharyngeal dysphagia. It’s related morbidity and mortality such as penetration-aspiration could progress to aspiration pneumonia, sepsis, and death if not treated properly. Factors suspected to be the determinants of penetration-aspiration were the location of the pharyngeal residue, the stage of NPC, and the time after radiotherapy. This primary objective of this study was to determine the clinical factors of penetration-aspiration in patients with NPC after radiotherapy. In a cross sectional, observational analytic study, a total of 24 patients were obtained with consecutive sampling technique. Fiberoptic endoscopic evaluation of swallowing (FEES) examination was performed on patients with NPC after radiotherapy to assess pharyngeal residue and penetration-aspiration. The Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS) and the Penetration-Aspiration Scale (PAS) was used to assess the presence of pharyngeal residue and penetration-aspiration, respectively. Statistical analysis used multiple logistic regression (p<0,05) and Wald statistics to find a stronger relationship between variables.

Downloads

Download data is not yet available.

References

Baudelet, M., Steen, L. V. D., Tomassen, P., Bonte, K., Deron, P., Huvenne, w. (2018). Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy. Head & Neck, 1:1-10. DOI: 10.1002/hed.25880.

Chang, Y., Chen, S., Thing, L., Peng, S. S., Wang, T. C., Wang, T. G. (2011). A 2-year follow-up of swallowing function after radiation therapy in patients with nasopharyngeal carcinoma. Arch Phys Med Rehabil, 92(11): 1814-9. DOI: 10.1016/j.apmr.2011.06.008.

Chen, Y. P., Chan, A. T. C., Le, Q. T., Blanchard, P., Sun, Y., Ma, J. (2019). Nasopharyngeal carcinoma. Lancet, 394(10192): 64-80. DOI: 10.1016/S0140-6736(19)30956-0.

Dewan, K. (2020). Chemotherapy and dysphagia: the good, the bad, the ugly. Curr Opin Otolaryngol Head Neck Surg, 28(6): 385-91. DOI: 10.1097/MOO.0000000000000672.

Greco, E., Simic, T., Ringash, J., Tomlinson, G., Inamoto, Y., Martino, R. (2018). Dysphagia treatment for patients with head and neck cancer treated with radiotherapy; a meta-analysis review. International Journal of Radiation Oncology, 101(2): 3-4. DOI: 10.1016/j.ijrobp.2018.01.097.

Ho, S. K. (2014). Chronic swallowing ability in nasopharyngeal cancer survivors after radiotherapy with or without chemotherapy. Disertation, The University of Hong Kong, Hong Kong.

Jiang, L., Huang, C., Gan, Y., Wu, T., Tang, X., Wang, Y. (2018). Radiation-induced late dysphagia after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients: a dose-volume effect analysis. Scientific Reports, 8(16396): 1-8. DOI: 10.1038/s41598-018-34803-y.

Kaae, J. K., Spejlborg, M. L., Spork, U., Bjorndal, K., Eriksen, J. G. (2020). Reducing late dysphagia for head and neck cancer survivors with oral gel: a feasibility study. Dysphagia, 35(2): 231-41. DOI: 10.1007/s00455-019-10018-9.

King, S. N., Dunlap, N. E., Tennant, P. A., Pitts, T. (2016). Pathophysiology of radiation-induced dysphagia in head and neck cancer. Dysphagia, 1:1-13. DOI: 10.1007/s00455-016-9710-1.

Ku, P., Vlantis, A. C., Leung, S. F., Lee, K. Y., Cheung, D. M., Abdullah, V. J. (2009). Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma. The Laryngoscope, 120(2): 223-8. DOI: 10.1002/lary.20701.

Langmore, S. E. & Krisciunas, G.P. (2010). Dysphagia after radiotherapy for head and neck cancer: etiology, clinical presentation, and efficacy of current treatments. American Speech-Language-Kearing Association, 19(2):30-56. DOI: https://doi.org/10.1044/sasd19.2.32

Li, H., Li, L., Huang, X., Li, Y., Zou, T., Zhuo, X. (2019). Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma. Strahlenther Onkol, 1:1-10. DOI: 10.1007/s00066-018-01421-6.

Luk, Y. S., Shum, J. S., Sze, H. C., Chan, L. L., Ng, W. T., Lee, A. W. (2013). Predictive factors and radiological features of radiation-induced cranial nerve palsy in patients with nasopharyngeal carcinoma after radical radiotherapy. Oral Oncology, 49(1): 49-54. DOI: 10.1016/j.oraloncology.2012.07.011.

Molfenter, S. M. & Steele, C. M. (2013). The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia 28(4): 494-500. DOI: 10.1007/s00455-013-9459-8.

Neubauer, P. D., Rademaker, A. W., Leder, S. B. (2015). The yale pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia, 30(5): 521-8. DOI: 10.1007/s00455-015-9631-4.

Nugroho, P. S., Yusuf, M., & Ahadiah, T. H. (2021). Correlation of cell proliferation with cervical lymphoid node status in nasopharyngeal carcinoma patients. Fol Med Indones, 57(1): 20-6. DOI: 10.20473/fmi.v57i1.8765.

Pisegna, J. M. (2017). Rethinking residue, an investigation of pharyngeal residue on flexible endoscopic evaluation of swallowing: the past, present, and future directions. Disertation. Massachusetts: Boston University.

Ratnawati, I. G. A. A., Suandayani, N. K. T., & Sutapa, G. N. (2019). The linearity of x-ray devices radiation output and its relationship with patient thickness. International Journal of Physical Sciences and Engineering, 3(3), 1–6. https://doi.org/10.29332/ijpse.v3n3.351

Romdhoni, A. C., Alkaff, F. F., Kahdina, M., Masturina, M., Ramadhani, R., Salamah, S. (2020). Clinical presentation of nasopharyngeal carcinoma in East Java, Indonesia. PJMHS, 14(3): 942-6.

Romdhoni, A. C., Aulia, R., Utaminingtyas, R. P., Suharjono, Alderman, C. P. (2020). Correlation of chemotherapy costs with quality of life in nasopharyngeal cancer patients. De Gruyter, 1:1-6. DOI: 10.1515/jbcpp-2019-0238.

Romdhoni, A. C., Herawati, S., Mustikaningtyas, E. (2016). Correlation between intracellular heat shock protein 70 expression and cervical lymph nodes enlargement in nasopharyngeal carcinoma. Fol Med Indones, 52(1): 24-34. DOI: 10.20473/fmi.v52i1.5205.

Simon, S. R., Florie, M., Pilz, W., Winkens, B., Winter, N., Kremer, B. (2019). Association between pharyngeal pooling and aspiration using fiberoptic endoscopic evaluation of swallowing in head and neck cancer patients with dysphagia. Dysphagia, 10:92-9. DOI: 10.1007/s00455-019-09992-x.

Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Health and treatment of diabetes mellitus. International Journal of Health Sciences, 5(1), i-v. https://doi.org/10.53730/ijhs.v5n1.2864

Susanti, N. L. P. D., Yuliana, E. D., & Suwardani, N. P. (2021). Management sewakadharma nurses in wangaya regional public hospitals. International Research Journal of Management, IT and Social Sciences, 8(3), 306-314. https://doi.org/10.21744/irjmis.v8n3.1717

Szczesniak, M. M., Maclean, J., Zhang, T., Graham, P. H., Cook, I. J. (2014). Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer related mortality. Clinical Oncology, 26(11): 697-703. DOI: 10.1016/j.clon.2014.08.009.