Dysphagia Severity and Aspiration Following Postoperative Radiation for Locally Advanced Oropharyngeal Cancer

The aim of the present study was to assess dysphagia severity following postoperative radiation for locally advanced oropharyngeal cancer. Patients and Methods: Eighteen patients with oropharyngeal carcinoma had undergone postoperative radiation. There were eight base of tongue, eight tonsils, and two soft palate carcinomas. All the patients had undergone modified barium swallow (MBS) to assess the persistence of dysphagia (more than one month) post-treatment. All the patients were cancer-free at the time of the swallowing study. Dysphagia severity was graded as 1-7. Results: At a median follow-up of 12 months, there were three grade 2, four grade 3, two grade 4, five grade 5, two grade 6, and two grade 7. Only three patients (17%) had normal swallow post-treatment. Six patients (33%) had mild to moderate dysphagia (grade 3-4). Nine patients (50%) developed aspiration (grade 5-7). Among the patients who developed aspiration, four (22%) required tube feeding for severe aspiration. Conclusion: Long-term (more than one year) dysphagia following postoperative radiation for oropharyngeal cancer may be symptomatic of permanent damage to the swallowing mechanism. Evaluation of patients who complain of persistence of dysphagia a year or more following treatment should include MBS, because of the increased risk of aspiration. The oropharynx plays a key role in modulating speech and swallowing and the management of oropharyngeal carcinoma remains a challenge for clinicians (1). Tumors arising in this anatomical location often produce dysphagia with the frequency of occurence proportional to the tumor volume and the percentage of the soft palate and tongue infiltrated by the tumor (2) and aspiration may be observed prior to treatment. Surgery has been the standard treatment for early stage oropharyngeal cancer, complete resection of the tumor requires removal of a rim of normal tissue surrounding the cancer. Surgery frequently produces severe dysphagia by