Skip to main content
Top
Published in: Dysphagia 2/2010

01-06-2010 | Review Article

Dysphagia in Head and Neck Cancer Patients Treated with Chemoradiotherapy

Authors: Nele Platteaux, Piet Dirix, Eddy Dejaeger, Sandra Nuyts

Published in: Dysphagia | Issue 2/2010

Login to get access

Abstract

Dysphagia is a very common complaint of head and neck cancer patients and can exist before, during, and after chemoradiotherapy. It leads to nutritional deficiency, weight loss, and prolonged unnatural feeding and also has a major potential risk for aspiration. This has a significant negative impact on the patient’s entire quality of life. Because treatment of dysphagia in this setting is rarely effective, prevention is paramount. Several strategies have been developed to reduce dysphagia. These include swallowing exercises, treatment modification techniques such as intensity-modulated radiotherapy, selective delineation of elective nodes, reducing xerostomia by parotid-sparing radiotherapy, and adding of radioprotectors. However, more research is needed to further decrease the incidence of dysphagia and improve quality of life.
Literature
1.
go back to reference Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–709.CrossRefPubMed Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–709.CrossRefPubMed
2.
go back to reference Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21(1):92–8.CrossRefPubMed Adelstein DJ, Li Y, Adams GL, Wagner H Jr, Kish JA, Ensley JF, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21(1):92–8.CrossRefPubMed
3.
go back to reference Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8.CrossRefPubMed Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8.CrossRefPubMed
4.
go back to reference Lefebvre JL. Laryngeal preservation in head and neck cancer: multidisciplinary approach. Lancet Oncol. 2006;7(9):747–55.CrossRefPubMed Lefebvre JL. Laryngeal preservation in head and neck cancer: multidisciplinary approach. Lancet Oncol. 2006;7(9):747–55.CrossRefPubMed
5.
go back to reference Ang KK, Harris J, Garden AS, Trotti A, Jones CU, Carrascosa L, et al. Concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: radiation therapy oncology group phase II trial 99–14. J Clin Oncol. 2005;23(13):3008–15.CrossRefPubMed Ang KK, Harris J, Garden AS, Trotti A, Jones CU, Carrascosa L, et al. Concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: radiation therapy oncology group phase II trial 99–14. J Clin Oncol. 2005;23(13):3008–15.CrossRefPubMed
6.
go back to reference Nuyts S, Dirix P, Clement PM, Poorten VV, Delaere P, Schoenaers J, et al. Van den Bogaert W, Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2008;73(4):1088–95.PubMed Nuyts S, Dirix P, Clement PM, Poorten VV, Delaere P, Schoenaers J, et al. Van den Bogaert W, Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2008;73(4):1088–95.PubMed
7.
go back to reference Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000;355(9208):949–55.PubMed Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet. 2000;355(9208):949–55.PubMed
8.
go back to reference Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998;338(25):1798–804.CrossRefPubMed Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998;338(25):1798–804.CrossRefPubMed
9.
go back to reference Budach W, Hehr T, Budach V, Belka C, Dietz K. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer. 2000;6:28.CrossRef Budach W, Hehr T, Budach V, Belka C, Dietz K. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer. 2000;6:28.CrossRef
10.
go back to reference Nuyts S, Dirix P, Hermans R, Poorten VV, Delaere P, Weltens C, et al. Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer. Head Neck. 2007;29(8):720–30.CrossRefPubMed Nuyts S, Dirix P, Hermans R, Poorten VV, Delaere P, Weltens C, et al. Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer. Head Neck. 2007;29(8):720–30.CrossRefPubMed
11.
go back to reference Pignon JP, Le Maitre A, Bourhis J. Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S112–4.PubMed Pignon JP, Le Maitre A, Bourhis J. Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S112–4.PubMed
12.
go back to reference Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53(1):23–8.PubMed Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53(1):23–8.PubMed
13.
go back to reference Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, et al. Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61(3):772–8.PubMed Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Karlsson U, et al. Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61(3):772–8.PubMed
14.
go back to reference Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol. 2006;80(3):302–6.CrossRefPubMed Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol. 2006;80(3):302–6.CrossRefPubMed
15.
go back to reference Langendijk JA, Doornaert P, Verdonck-de Leeuw I, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770–6.CrossRefPubMed Langendijk JA, Doornaert P, Verdonck-de Leeuw I, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770–6.CrossRefPubMed
16.
go back to reference Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002;9(5):400–9.PubMed Gaziano JE. Evaluation and management of oropharyngeal dysphagia in head and neck cancer. Cancer Control. 2002;9(5):400–9.PubMed
17.
go back to reference Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, et al. Swallowing dysfunction–preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys. 2003;57(5):1219–30.PubMed Mittal BB, Pauloski BR, Haraf DJ, Pelzer HJ, Argiris A, Vokes EE, et al. Swallowing dysfunction–preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys. 2003;57(5):1219–30.PubMed
18.
go back to reference Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24(17):2636–43.CrossRefPubMed Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006;24(17):2636–43.CrossRefPubMed
19.
go back to reference Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg. 2000;126(3):384–9.PubMed Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg. 2000;126(3):384–9.PubMed
20.
go back to reference Teguh DN, Levendag PC, Noever I, van Rooij P, Voet P, van der Est H, et al. Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys. 2008;72(4):1119–27.PubMed Teguh DN, Levendag PC, Noever I, van Rooij P, Voet P, van der Est H, et al. Treatment techniques and site considerations regarding dysphagia-related quality of life in cancer of the oropharynx and nasopharynx. Int J Radiat Oncol Biol Phys. 2008;72(4):1119–27.PubMed
21.
go back to reference Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15(3):383–8.CrossRefPubMed Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15(3):383–8.CrossRefPubMed
22.
go back to reference Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Mittal B, Gaziano J, et al. Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation. Head Neck. 2003;25(6):432–7.CrossRefPubMed Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Mittal B, Gaziano J, et al. Xerostomia: 12-month changes in saliva production and its relationship to perception and performance of swallow function, oral intake, and diet after chemoradiation. Head Neck. 2003;25(6):432–7.CrossRefPubMed
23.
go back to reference Nguyen NP, Vos P, Moltz CC, Frank C, Millar C, Smith HJ, et al. Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. Br J Radiol. 2008;81(969):706–10.CrossRefPubMed Nguyen NP, Vos P, Moltz CC, Frank C, Millar C, Smith HJ, et al. Analysis of the factors influencing dysphagia severity upon diagnosis of head and neck cancer. Br J Radiol. 2008;81(969):706–10.CrossRefPubMed
24.
go back to reference Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, et al. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006;28(1):64–73.CrossRefPubMed Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, et al. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006;28(1):64–73.CrossRefPubMed
25.
go back to reference Pauloski BR, Rademaker AW, Logemann JA, Stein D, Beery Q, Newman L, et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22(5):474–82.CrossRefPubMed Pauloski BR, Rademaker AW, Logemann JA, Stein D, Beery Q, Newman L, et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck. 2000;22(5):474–82.CrossRefPubMed
26.
go back to reference Stenson KM, MacCracken E, List M, Haraf DJ, Brockstein B, Weichselbaum R, et al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2000;126(3):371–7.PubMed Stenson KM, MacCracken E, List M, Haraf DJ, Brockstein B, Weichselbaum R, et al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg. 2000;126(3):371–7.PubMed
27.
go back to reference Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2008;73(2):410–5.PubMed Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2008;73(2):410–5.PubMed
28.
go back to reference Gillespie MB, Brodsky MB, Day TA, Lee FS, Martin-Harris B. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope. 2004;114(8):1362–7.CrossRefPubMed Gillespie MB, Brodsky MB, Day TA, Lee FS, Martin-Harris B. Swallowing-related quality of life after head and neck cancer treatment. Laryngoscope. 2004;114(8):1362–7.CrossRefPubMed
29.
go back to reference Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9.CrossRefPubMed Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9.CrossRefPubMed
30.
go back to reference Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy–results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50(5):1161–71.PubMed Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy–results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50(5):1161–71.PubMed
31.
go back to reference Nguyen NP, Sallah S, Karlsson U, Antoine JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer. 2002;94(4):1131–41.CrossRefPubMed Nguyen NP, Sallah S, Karlsson U, Antoine JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer. 2002;94(4):1131–41.CrossRefPubMed
32.
go back to reference Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Evolution of chronic dysphagia following treatment for head and neck cancer. Oral Oncol. 2006;42(4):374–80.CrossRefPubMed Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Evolution of chronic dysphagia following treatment for head and neck cancer. Oral Oncol. 2006;42(4):374–80.CrossRefPubMed
33.
go back to reference Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, et al. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg. 2006;134(6):916–22.CrossRefPubMed Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, et al. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer. Otolaryngol Head Neck Surg. 2006;134(6):916–22.CrossRefPubMed
34.
go back to reference Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia. 2003;18(2):135–43.CrossRefPubMed Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, et al. Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Dysphagia. 2003;18(2):135–43.CrossRefPubMed
35.
go back to reference Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C3.0 (version 30) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer. 2000;36(14):1796–807.CrossRefPubMed Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C3.0 (version 30) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer. 2000;36(14):1796–807.CrossRefPubMed
36.
go back to reference Sherman AC, Simonton S, Adams DC, Vural E, Owens B, Hanna E. Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H&N35). Arch Otolaryngol Head Neck Surg. 2000;126(4):459–67.PubMed Sherman AC, Simonton S, Adams DC, Vural E, Owens B, Hanna E. Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H&N35). Arch Otolaryngol Head Neck Surg. 2000;126(4):459–67.PubMed
37.
go back to reference List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, et al. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale A study of utility and validity. Cancer. 1996;77(11):2294–301.CrossRefPubMed List MA, D’Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, et al. The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale A study of utility and validity. Cancer. 1996;77(11):2294–301.CrossRefPubMed
38.
go back to reference List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K, et al. Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol. 1999;17(3):1020–8.PubMed List MA, Siston A, Haraf D, Schumm P, Kies M, Stenson K, et al. Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. J Clin Oncol. 1999;17(3):1020–8.PubMed
39.
go back to reference Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116(6):883–6.CrossRefPubMed Kulbersh BD, Rosenthal EL, McGrew BM, Duncan RD, McColloch NL, Carroll WR, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006;116(6):883–6.CrossRefPubMed
40.
go back to reference Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–6.PubMed Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870–6.PubMed
41.
go back to reference List MA, Mumby P, Haraf D, Siston A, Mick R, MacCracken E, et al. Performance and quality of life outcome in patients completing concomitant chemoradiotherapy protocols for head and neck cancer. Qual Life Res. 1997;6(3):274–84.CrossRefPubMed List MA, Mumby P, Haraf D, Siston A, Mick R, MacCracken E, et al. Performance and quality of life outcome in patients completing concomitant chemoradiotherapy protocols for head and neck cancer. Qual Life Res. 1997;6(3):274–84.CrossRefPubMed
42.
go back to reference Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, et al. Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys. 2008;70(2):330–7.PubMed Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, et al. Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys. 2008;70(2):330–7.PubMed
43.
go back to reference Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341–6.PubMed Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341–6.PubMed
44.
go back to reference Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, et al. Late toxicity results of the GORTEC 94–01 randomized trial comparing radiotherapy with concomitant radiochemotherapy for advanced-stage oropharynx carcinoma: comparison of LENT/SOMA, RTOG/EORTC, and NCI-CTC scoring systems. Int J Radiat Oncol Biol Phys. 2003;55(1):93–8.CrossRefPubMed Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, et al. Late toxicity results of the GORTEC 94–01 randomized trial comparing radiotherapy with concomitant radiochemotherapy for advanced-stage oropharynx carcinoma: comparison of LENT/SOMA, RTOG/EORTC, and NCI-CTC scoring systems. Int J Radiat Oncol Biol Phys. 2003;55(1):93–8.CrossRefPubMed
45.
go back to reference Logemann JA. Evaluation, treatment of swallowing disorders. San Diego, CA: College Hill Press; 1983. p. 3–70. Logemann JA. Evaluation, treatment of swallowing disorders. San Diego, CA: College Hill Press; 1983. p. 3–70.
46.
go back to reference Logemann JA. Manual for the videofluorographic study of swallowing. San Diego, CA: College Hill Press; 1986. Logemann JA. Manual for the videofluorographic study of swallowing. San Diego, CA: College Hill Press; 1986.
47.
go back to reference Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008;30(2):148–58.CrossRefPubMed Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Gaziano J, Stachowiak L, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008;30(2):148–58.CrossRefPubMed
48.
go back to reference McConnel FM, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Laryngoscope. 1988;98(7):705–11.CrossRefPubMed McConnel FM, Cerenko D, Jackson RT, Hersh T. Clinical application of the manofluorogram. Laryngoscope. 1988;98(7):705–11.CrossRefPubMed
49.
go back to reference Hila A, Castell JA, Castell DO. Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia. J Clin Gastroenterol. 2001;33(5):355–61.CrossRefPubMed Hila A, Castell JA, Castell DO. Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia. J Clin Gastroenterol. 2001;33(5):355–61.CrossRefPubMed
50.
go back to reference Bastian RW. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol Head Neck Surg. 1991;104(3):339–50.PubMed Bastian RW. Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol Head Neck Surg. 1991;104(3):339–50.PubMed
51.
go back to reference Jensen K, Lambertsen K, Grau C. Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol. 2007;85(1):74–82.CrossRefPubMed Jensen K, Lambertsen K, Grau C. Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol. 2007;85(1):74–82.CrossRefPubMed
52.
go back to reference Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110(4):563–74.CrossRefPubMed Aviv JE. Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Laryngoscope. 2000;110(4):563–74.CrossRefPubMed
53.
go back to reference Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723–7.CrossRefPubMed Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723–7.CrossRefPubMed
54.
go back to reference Teguh DN, Levendag PC, Sewnaik A, Hakkesteegt MM, Noever I, Voet P, et al. Results of fiberoptic endoscopic evaluation of swallowing vs. radiation dose in the swallowing muscles after radiotherapy of cancer in the oropharynx. Radiother Oncol. 2008;89(1):57–63.CrossRefPubMed Teguh DN, Levendag PC, Sewnaik A, Hakkesteegt MM, Noever I, Voet P, et al. Results of fiberoptic endoscopic evaluation of swallowing vs. radiation dose in the swallowing muscles after radiotherapy of cancer in the oropharynx. Radiother Oncol. 2008;89(1):57–63.CrossRefPubMed
55.
go back to reference Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396–401.CrossRefPubMed Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396–401.CrossRefPubMed
56.
go back to reference Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60(5):1425–39.PubMed Eisbruch A, Schwartz M, Rasch C, Vineberg K, Damen E, Van As CJ, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60(5):1425–39.PubMed
57.
go back to reference Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, et al. Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck. 2002;24(6):555–65.CrossRefPubMed Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, et al. Swallow function and perception of dysphagia in patients with head and neck cancer. Head Neck. 2002;24(6):555–65.CrossRefPubMed
58.
go back to reference Jensen K, Bonde JA, Grau C. The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires. Radiother Oncol. 2006;78(3):298–305.CrossRefPubMed Jensen K, Bonde JA, Grau C. The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires. Radiother Oncol. 2006;78(3):298–305.CrossRefPubMed
59.
go back to reference Murry T, Madasu R, Martin A, Robbins KT. Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer. Head Neck. 1998;20(1):31–7.CrossRefPubMed Murry T, Madasu R, Martin A, Robbins KT. Acute and chronic changes in swallowing and quality of life following intraarterial chemoradiation for organ preservation in patients with advanced head and neck cancer. Head Neck. 1998;20(1):31–7.CrossRefPubMed
60.
go back to reference List MA, Stracks J. Evaluation of quality of life in patients definitively treated for squamous carcinoma of the head and neck. Curr Opin Oncol. 2000;12(3):215–20.CrossRefPubMed List MA, Stracks J. Evaluation of quality of life in patients definitively treated for squamous carcinoma of the head and neck. Curr Opin Oncol. 2000;12(3):215–20.CrossRefPubMed
61.
go back to reference Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, et al. Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope. 2005;115(12):2183–92.CrossRefPubMed Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, et al. Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope. 2005;115(12):2183–92.CrossRefPubMed
62.
go back to reference Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994;110(2):222–7.PubMed Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg. 1994;110(2):222–7.PubMed
63.
go back to reference Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51(4–5):199–212.CrossRefPubMed Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51(4–5):199–212.CrossRefPubMed
64.
go back to reference Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118(1):39–43.CrossRefPubMed Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118(1):39–43.CrossRefPubMed
65.
66.
go back to reference Waters TM, Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Newman LA, et al. Beyond efficacy and effectiveness: conducting economic analyses during clinical trials. Dysphagia. 2004;19(2):109–19.CrossRefPubMed Waters TM, Logemann JA, Pauloski BR, Rademaker AW, Lazarus CL, Newman LA, et al. Beyond efficacy and effectiveness: conducting economic analyses during clinical trials. Dysphagia. 2004;19(2):109–19.CrossRefPubMed
67.
go back to reference Ahlawat SK, Al-Kawas FH. Endoscopic management of upper esophageal strictures after treatment of head and neck malignancy. Gastrointest Endosc. 2008;68(1):19–24.CrossRefPubMed Ahlawat SK, Al-Kawas FH. Endoscopic management of upper esophageal strictures after treatment of head and neck malignancy. Gastrointest Endosc. 2008;68(1):19–24.CrossRefPubMed
68.
go back to reference Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJ, et al. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85(1):64–73.CrossRefPubMed Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJ, et al. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85(1):64–73.CrossRefPubMed
69.
go back to reference Antonadou D, Pepelassi M, Synodinou M, Puglisi M, Throuvalas N. Prophylactic use of amifostine to prevent radiochemotherapy-induced mucositis and xerostomia in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;52(3):739–47.CrossRefPubMed Antonadou D, Pepelassi M, Synodinou M, Puglisi M, Throuvalas N. Prophylactic use of amifostine to prevent radiochemotherapy-induced mucositis and xerostomia in head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;52(3):739–47.CrossRefPubMed
70.
go back to reference Brizel DM, Wasserman TH, Henke M, Strnad V, Rudat V, Monnier A, et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol. 2000;18(19):3339–45.PubMed Brizel DM, Wasserman TH, Henke M, Strnad V, Rudat V, Monnier A, et al. Phase III randomized trial of amifostine as a radioprotector in head and neck cancer. J Clin Oncol. 2000;18(19):3339–45.PubMed
71.
go back to reference Buntzel J, Glatzel M, Kuttner K, Weinaug R, Frohlich D. Amifostine in simultaneous radiochemotherapy of advanced head and neck cancer. Semin Radiat Oncol. 2002;12(1 Suppl 1):4–13.CrossRefPubMed Buntzel J, Glatzel M, Kuttner K, Weinaug R, Frohlich D. Amifostine in simultaneous radiochemotherapy of advanced head and neck cancer. Semin Radiat Oncol. 2002;12(1 Suppl 1):4–13.CrossRefPubMed
72.
go back to reference Eisbruch A. Dysphagia and aspiration following chemo-irradiation of head and neck cancer: major obstacles to intensification of therapy. Ann Oncol. 2004;15(3):363–4.CrossRefPubMed Eisbruch A. Dysphagia and aspiration following chemo-irradiation of head and neck cancer: major obstacles to intensification of therapy. Ann Oncol. 2004;15(3):363–4.CrossRefPubMed
73.
go back to reference Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49(4):907–16.CrossRefPubMed Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49(4):907–16.CrossRefPubMed
74.
go back to reference Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50(3):695–704.PubMed Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50(3):695–704.PubMed
75.
go back to reference Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45(3):577–87.PubMed Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA. Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys. 1999;45(3):577–87.PubMed
76.
go back to reference Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):1110–8.PubMed Caglar HB, Tishler RB, Othus M, Burke E, Li Y, Goguen L, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):1110–8.PubMed
77.
go back to reference Eisbruch A, Levendag PC, Feng FY, Teguh D, Lyden T, Schmitz PI, et al. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40–2.PubMed Eisbruch A, Levendag PC, Feng FY, Teguh D, Lyden T, Schmitz PI, et al. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40–2.PubMed
78.
go back to reference Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68(5):1289–98.PubMed Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68(5):1289–98.PubMed
79.
go back to reference Bussels B, Maes A, Hermans R, Nuyts S, Weltens C, Van den Bogaert W. Recurrences after conformal parotid-sparing radiotherapy for head and neck cancer. Radiother Oncol. 2004;72(2):119–27.CrossRefPubMed Bussels B, Maes A, Hermans R, Nuyts S, Weltens C, Van den Bogaert W. Recurrences after conformal parotid-sparing radiotherapy for head and neck cancer. Radiother Oncol. 2004;72(2):119–27.CrossRefPubMed
80.
go back to reference Bussels B, Hermans R, Reijnders A, Dirix P, Nuyts S, Van den Bogaert W. Retropharyngeal nodes in squamous cell carcinoma of oropharynx: incidence, localization, and implications for target volume. Int J Radiat Oncol Biol Phys. 2006;65(3):733–8.PubMed Bussels B, Hermans R, Reijnders A, Dirix P, Nuyts S, Van den Bogaert W. Retropharyngeal nodes in squamous cell carcinoma of oropharynx: incidence, localization, and implications for target volume. Int J Radiat Oncol Biol Phys. 2006;65(3):733–8.PubMed
81.
go back to reference Eisbruch A, Marsh LH, Dawson LA, Bradford CR, Teknos TN, Chepeha DB, et al. Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys. 2004;59(1):28–42.PubMed Eisbruch A, Marsh LH, Dawson LA, Bradford CR, Teknos TN, Chepeha DB, et al. Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys. 2004;59(1):28–42.PubMed
82.
go back to reference Lewin JS. Dysphagia after chemoradiation: prevention and treatment. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S86–7.PubMed Lewin JS. Dysphagia after chemoradiation: prevention and treatment. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S86–7.PubMed
83.
go back to reference Rosen A, Rhee TH, Kaufman R. Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 2001;127(8):975–9.PubMed Rosen A, Rhee TH, Kaufman R. Prediction of aspiration in patients with newly diagnosed untreated advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 2001;127(8):975–9.PubMed
84.
go back to reference Wu CH, Hsiao TY, Ko JY, Hsu MM. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol. 2000;109(3):320–5.PubMed Wu CH, Hsiao TY, Ko JY, Hsu MM. Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma. Ann Otol Rhinol Laryngol. 2000;109(3):320–5.PubMed
85.
go back to reference Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Long-term aspiration following treatment for head and neck cancer. Oncology. 2008;74(1–2):25–30.CrossRefPubMed Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Long-term aspiration following treatment for head and neck cancer. Oncology. 2008;74(1–2):25–30.CrossRefPubMed
86.
go back to reference Hughes PJ, Scott PM, Kew J, Cheung DM, Leung SF, Ahuja AT, et al. Dysphagia in treated nasopharyngeal cancer. Head Neck. 2000;22(4):393–7.CrossRefPubMed Hughes PJ, Scott PM, Kew J, Cheung DM, Leung SF, Ahuja AT, et al. Dysphagia in treated nasopharyngeal cancer. Head Neck. 2000;22(4):393–7.CrossRefPubMed
87.
go back to reference Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Nguyen PD, et al. Impact of swallowing therapy on aspiration rate following treatment for locally advanced head and neck cancer. Oral Oncol. 2007;43(4):352–7.CrossRefPubMed Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Nguyen PD, et al. Impact of swallowing therapy on aspiration rate following treatment for locally advanced head and neck cancer. Oral Oncol. 2007;43(4):352–7.CrossRefPubMed
88.
go back to reference Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40.CrossRefPubMed Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Super-supraglottic swallow in irradiated head and neck cancer patients. Head Neck. 1997;19(6):535–40.CrossRefPubMed
89.
go back to reference Dornfeld K, Simmons JR, Karnell L, Karnell M, Funk G, Yao M, et al. Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Int J Radiat Oncol Biol Phys. 2007;68(3):750–7.PubMed Dornfeld K, Simmons JR, Karnell L, Karnell M, Funk G, Yao M, et al. Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Int J Radiat Oncol Biol Phys. 2007;68(3):750–7.PubMed
90.
go back to reference Fua TF, Corry J, Milner AD, Cramb J, Walsham SF, Peters LJ. Intensity-modulated radiotherapy for nasopharyngeal carcinoma: clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat Oncol Biol Phys. 2007;67(4):976–81.PubMed Fua TF, Corry J, Milner AD, Cramb J, Walsham SF, Peters LJ. Intensity-modulated radiotherapy for nasopharyngeal carcinoma: clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat Oncol Biol Phys. 2007;67(4):976–81.PubMed
91.
go back to reference Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S, Dysphagia after radiotherapy for head and neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2009:1–8 (in press). Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S, Dysphagia after radiotherapy for head and neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2009:1–8 (in press).
Metadata
Title
Dysphagia in Head and Neck Cancer Patients Treated with Chemoradiotherapy
Authors
Nele Platteaux
Piet Dirix
Eddy Dejaeger
Sandra Nuyts
Publication date
01-06-2010
Publisher
Springer-Verlag
Published in
Dysphagia / Issue 2/2010
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-009-9247-7

Other articles of this Issue 2/2010

Dysphagia 2/2010 Go to the issue