Each year there are about 1,000 new cases of head and neck cancer (HNC) in Denmark. Most patients are treated with radiotherapy and/or surgery. While the results of radiotherapy for HNC has substantially improved, a significant proportion of the patients still have major chronic side effects. Dysphagia and swallowing problems are the most troublesome, leading to reduced quality of life, malnutrition and aspiration pneumonia. Various studies have shown that both subjective and objective swallowing problems are frequent and severe. Research confirmed that most problems correlating with dose and volume parameters of the upper aero-digestive tract.

At the 3rd International Conference on innovative approaches in Head and Neck Oncology (ICHNO), Hanna Rahbek Mortensen, PhD and colleagues at hospitals and institutes in Denmark presented results from a large prospective trial, the DAHANCA 6 & 7 study. The study, conducted across the Denmark, investigated risk factors for developing dysphagia (swallowing dysfunction), after undergoing radiotherapy treatment for a head & neck cancer. ?We followed 1,476 patients with squamous cell carcinoma of the head and neck and found out the existence of factors related to the cancer itself, to the patient and to the treatment influencing the development of dysphagia,? Mortensen noted.

Dysphagia may be acute (starting in direct association with treatment) or late (starting months to years after treatment). Risk factors for developing severe acute dysphagia were large tumours, spreading of cancer cells to the lymph nodes, swallowing problems at the time of diagnosis, 6 treatments per week and tumour location other than the vocal cords. Risk factors for developing late dysphagia were large tumours, swallowing problems at the time of diagnosis and tumour location other than the vocal cords.

83% of all head & neck cancer patients develop some kind of dysphagia, but this predictive model will have a major impact on patient quality of life.

Lower risks on xerostomia
?These results are very important,? said Hans Langendijk, M.D. from the University Medical Center of Groningen, The Netherlands. ?Today, with the increasing use of intensity modulated radiotherapy (IMRT), the dose to the salivary glands is reduced resulting in lower risks of xerostomia (dry mouth). However, swallowing dysfunction is remaining an important side effect following irradiation in the head and neck region. Therefore, the identification of patients that are at highest risk for dysphagia, in particular late and persistent, is of major importance as this will help us to provide them with preventive measures?, Langendijk noted.

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Gastric tubes insertion and swallowing exercises could be prescribed and prevent malnutrition and weight loss. ?This study will be very helpful to improve the quality of life of patients,? Mortensen noted. ?Indeed, these measures at an early stage of the treatment will considerably reduce swallowing disorders?.But the results will also lead to a better treatment. ?Dysphagia is a limiting factor for further intensification of head and neck radiotherapy. This is why the knowledge provided here may help us to better tailor treatments for the patients: it may allow us to increase the intensity of the treatment while maintaining their quality of life,? Mortensen concluded.

For more information:
Mortensen HR, Jensen K, Grau C. Reduction of Dysphagia-related Morbidity in Head and Neck Radiotherapy P21.07, Department of Oncology, Aarhus University Hospital (PhD Day January 14, 2011)

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