dysphagia

Clinical and dosimetric factors associated with a prolonged feeding tube requirement in patients treated with chemoradiotherapy (CRT) for head and neck cancers

Source: Annals of Oncology, doi:10.1093/annonc/mdp268 Authors: A. S. Gokhale et al. Background: Patients treated with chemoradiotherapy (CRT) for head and neck cancers often require feeding tubes (FTs) due to toxicity. We sought to identify factors associated with a prolonged FT requirement. Patients and methods: We retrospectively reviewed 80 patients treated with CRT for head and neck cancers. The pharyngeal constrictors (PCs), supraglottic larynx (SGL), and glottic larynx (GL) were contoured and the mean radiation doses and the volumes of each receiving >40, 50, 60, and 70 Gy (V40, V50, V60, and V70) were determined. Results: A total of 33 of 80 patients required a FT either before or during the course of CRT. Fifteen patients required the FT for ≥6 months. On univariate analysis, significant factors associated with a prolonged FT requirement were mean PC dose, PC-V60, PC-V70, SGL dose, SGL-V70, and advanced T3–T4 disease. Multivariate analyses found both PC-V70 and T3-T4 disease as significant factors .The proportions of patients requiring a FT ≥6 months were 8% and 28% for treatment plans with PC-V70 <30% and ≥30%, respectively. Conclusions: Increased radiation dose to the PCs is associated with a higher risk of a prolonged FT need. Dose sparing of the PC muscles may reduce this risk. Authors: A. S. Gokhale1, B. T. McLaughlin2, J. C. Flickinger1, S. Beriwal1,*, D. E. Heron1, R. L. Ferris3, J. Johnson3, M. K. Gibson2, A. Argiris2 and R. P. Smith1 Authors' affiliatons: 1 Department of Radiation Oncology 2 Division of Hematology–Oncology, Department of Medicine 3 [...]

Oral Cancer Foundation News Team - A2009-07-15T13:03:53-07:00July, 2009|Oral Cancer News|

Effectiveness of VitalStim therapy for patients suffering in published study

Source: Reuters.com Author: Staff Published Study Demonstrates Effectiveness of VitalStim Therapy for Patients Suffering with Dysphagia A recent study published in the April 2008 issue of the Annals of Otology, Rhinology & Laryngology has revealed the positive clinical effect of the adjunctive use of VitalStim(R) Therapy. A leading brand within the Empi Recovery Sciences line of pain management and rehabilitation products, VitalStim is a non-invasive neuromuscular electrical stimulation (NMES) device for the treatment of dysphagia. Results of the study were also originally presented at the American Association of Speech-Language Pathology Conference in Miami, Fla. in November 2006. Dysphagia, or difficulty swallowing, is a sorely neglected medical condition which affects 15 million Americans and is generally caused by a neurological disorder or event, such as a stroke, degenerative neurological diseases and head and neck cancer. Without proper management, dysphagia can lead to aspiration, pneumonia, choking, chronic malnutrition, severe life-threatening dehydration, an increased rate of infection, longer hospital stays, long-term institutional care and even death. VitalStim Therapy is a non-invasive external electrical stimulation therapy that was cleared to market by the FDA in December 2002. VitalStim is a portable, dual-channel electrotherapy system that is used with electrodes specifically designed for application to the muscles of the throat to promote swallowing. Entitled "Adjunctive Neuromuscular Electrical Stimulation for Treatment-Refractory Dysphagia," the study details the measured clinical effect of the VitalStim program on six patients with chronic, treatment-refractive dysphagia. The study describes a prospective case series using validated outcome measures to represent different domains and [...]

Charlotte Parker2009-07-15T13:04:51-07:00July, 2009|Oral Cancer News|

Refeeding syndrome – awareness, prevention and management

Source: Head &Neck Oncology 2009, 1:4 Authors: Hisham M Mehanna, Paul C Nankivell, Jamil Moledina and Jane Travis Refeeding syndrome is an important, yet commonly overlooked condition affecting patients. It occurs when feeding is commenced after a period of starvation. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake. This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of patients. Awareness of the condition is crucial in identifying patients at risk and taking measures to prevent its occurrence. Objectives: The aims of this review are to: 1) Highlight the condition and stress the importance of its consideration when admitting head and neck cancer patients. 2) Discuss the pathophysiology behind refeeding syndrome. 3) Review the literature for the best available evidence and guidelines. 4) Highlight the need for further high quality research. Conclusion: Refeeding syndrome is potentially fatal, yet is preventable. Awareness and identification of at-risk patients is crucial to improving management. Refeeding syndrome is caused by rapid refeeding after a period of under-nutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications. High risk patients include the chronically under-nourished and those with little intake for greater than 10 days. Patients with dysphagia are at particular risk. Refeeding should commence at 10kcal/kg per day in patients at risk, and increased slowly. Thiamine, vitamin B complex and multi-vitamin supplements should be started with refeeding. New NICE guidelines state that pre-feeding [...]

Oral Cancer Foundation News Team - A2009-01-26T15:23:20-07:00January, 2009|Oral Cancer News|

Favourable impact of intensity-modulated radiation therapy on chronic dysphagia in patients with head and neck cancer

Source: British Journal of Radiology (2008) 81, 865-871 Authors: A. K. Anand, MD et al. The aim of this study was to evaluate the impact of intensity-modulated radiation therapy (IMRT) on the incidence and severity of chronic dysphagia in patients with head and neck cancer. 62 evaluable patients with head and neck cancer who were treated with IMRT with or without concurrent chemotherapy were analysed. The majority of the patients (77.4%) had advanced locoregional disease. 45 patients underwent definitive IMRT and 17 received post-operative IMRT. Concurrent chemotherapy was given to 29 of the 45 patients treated with definitive IMRT. The average prescribed dose to clinical target volume (CTV)1 was 66–70 Gy (definitive IMRT) and 56–62 Gy (post-operative IMRT); 60 Gy to CTV2; 54 Gy to CTV3; and 50–52 Gy to the supraclavicular area. At a median follow-up of 19 months, 2-year actuarial locoregional control and survival was 77% and 74%, respectively. At 6 months after IMRT, chronic dysphagia was Grade 0 in 77.1% of patients, Grade 1 in 10.5% and Grade 2 in 12.3%. Acute mucositis showed no correlation with long-term dysphagia. The percutaneous endoscopic gastrostomy or nasogastric tube was removed in all of the patients within 8 weeks of completion of treatment. Xerostomia was Grade 0 in 61.4% of patients, Grade 1 in 31.5% and Grade 2 in 7% of patients. In conclusion, IMRT conferred a major favourable impact on chronic dysphagia in patients with locally advanced head and neck cancers, with satisfactory locoregional control. Authors: A. K. Anand, [...]

Oral Cancer Foundation News Team - A2008-10-24T06:49:50-07:00October, 2008|Oral Cancer News|