Correlation Between Saliva Production and Quality of Life Measurements in Head and Neck Cancer Patients Treated With Intensity-Modulated Radiotherapy Dose-dependent deterioration of swallowing function after induction chemotherapy and definitive chemoradiotherapy for laryngopharyngeal cancer Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy A Randomized Preventive Rehabilitation Trial in Advanced Head and Neck Cancer Patients Treated with Chemoradiotherapy: Feasibility, Compliance, and Short-term Effects Mobilization regimens for the prevention of jaw hypomobility in the radiated patient: a comparison of three techniques. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises A prospective longitudinal study of voice characteristics and health-related quality of life outcomes following laryngeal cancer treatment with radiotherapy Toxicity, quality of life, and functional outcomes of 176 hypopharyngeal cancer patients treated by (chemo)radiation: the impact of treatment modality and radiation technique. Survey of Usual Practice: Dysphagia Therapy in Head and Neck Cancer Patients Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer High survival and organ function rates after primary chemoradiotherapy for intermediate-stage squamous cell carcinoma of the head and neck treated in a multicenter phase II trial. Functional Outcomes and Quality of Life After Chemoradiotherapy: Baseline and 3 and 6 Months Post-Treatment Dosimetric predictors of dysphonia after intensity-modulated radiotherapy for oropharyngeal carcinoma. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. A novel dose constraint to reduce xerostomia in head-and-neck cancer patients treated with intensity-modulated radiotherapy. Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with radiotherapy: A randomised controlled trial Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. Factors affecting the quality of voice in the early glottic cancer treated with radiotherapy. Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy. First-year quality of life assessment of an intra-arterial (RADPLAT) versus intravenous chemoradiation phase III trial. 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. An international phase 3 trial in head and neck cancer: Quality of life and symptom results Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results. Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer Electroglottographic comparison of voice outcomes in patients with advanced laryngopharyngeal cancer treated by chemoradiotherapy or total laryngectomy. Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Voice outcomes after radiotherapy treatment for early glottic cancer: assessment using multidimensional tools. Pre- and posttreatment voice and speech outcomes in patients with advanced head and neck cancer treated with chemoradiotherapy: expert listeners' and patient's perception. Impact of demographics, tumor characteristics, and treatment factors on swallowing after (chemo)radiotherapy for head and neck cancer.
Purpose : To investigate the strength of correlation between measured saliva flow rates and various toxicity endpoints commonly used in head and neck cancer ( HNC ) treatment . Material s and Methods : All patients enrolled in a phase II study using intensity modulated radiotherapy ( IMRT ) for HNC treatment underwent whole mouth saliva flow measurements ( stimulated and unstimulated ) . They were also assessed for salivary gl and toxicity using  Radiation Therapy Oncology Group ( RTOG ) late toxicity grading and 9 items  representing  patient-  grade d  toxicities  from 2 question naires ( Xerostomia question naire and University of Washington quality of life ) . For each patient , saliva flow rates and quality of life ( QOL ) data were collected preradiotherapy ( RT ) and at 3 intervals post-RT ( 3 , 6 , and 12 months ) . Results : A total of 188 sets of coregistered data were obtained for 47 patients over a period of approximately 4 years .  Saliva production and mean QOL dropped significantly immediately after RT , but there was a statistically significant recovery in both parameters between 3- and 12-month post-RT . By 12 months , post-RT the mean QOL scores had returned to pre-RT baseline , although mean stimulated saliva production remained 58 % below baseline . Conclusion : Patients with HNC treated with IMRT  experienced a small drop in QOL which recovered to baseline by 12 months post-RT . There was no statistically significant correlation seen between global health-related QOL scores and stimulated saliva production rates in the post-RT period Aim To evaluate the influence of clinical , treatment- and dose-dependent factors on posttreatment swallowing function after induction chemotherapy and definitive chemoradiotherapy in a group of homogeneously treated laryngopharyngeal cancer patients . Methods From 28 May 2008 to 15 February 2013 , 45 patients with borderline inoperable laryngopharyngeal cancer that had responded well to induction chemotherapy were treated with definitive chemoradiotherapy .  Median follow-up was 22 months . Swallowing function and clinical data were prospect ively analyzed using the EORTC QLQ-C30 question naire . Swallowing structures were retrospectively delineated on the original treatment planning CT .  Dose – volume histograms were calculated for swallowing structures and Dmean , Dmax and V50–V64 values ( in 2 Gy increments ) were determined for each patient . Tumor volume and infiltration of the swallowing apparatus was defined by CT before induction chemotherapy . Results Of the 45 patients , 26 ( 57.8 % ) fully regained swallowing function after chemoradiotherapy . A further 12 patients ( 26.7 % ) were able to manage soft , pureed and /or liquid foods ; the remaining 7 ( 15.6 % ) were completely dependent on percutaneous endoscopic gastrostomy ( PEG ) . Posttreatment swallowing function was significantly influenced by Dmean to the superior pharyngeal constrictor muscle ( PCM , p = 0.041 ) . Correlations between late dysphagia and dose – volume relationships in the superior PCM and soft palate were also observed , which were significant from V60 ( p = 0.043 ) and V58 for the soft palate and superior PCM , respectively . Of the evaluated clinical and tumor-related factors , only alcohol abuse ( p = 0.024 ) had an influence on posttreatment swallowing function . Conclusion Almost 50 % of patients had deterioration of swallowing function after definitive chemoradiotherapy for laryngopharyngeal cancer . The dose to anatomical structures responsible for swallowing function appears to play a role . Therefore , in selected patients , target volume delineation for radiotherapy of laryngopharyngeal cancer should be optimized on an individual basis to spare the swallowing apparatus . ZusammenfassungZielEvaluation von klinischen , therapie- und dosisabhängigen Faktoren in Bezug auf die posttherapeutische Schluckfunktion nach Induktionschemotherapie und definitiver Radiochemotherapie bei einem homogen beh and elten Patientenkollektiv mit laryngopharyngealen Tumoren . Method enIm Zeitraum vom 28 . Mai 2008 bis 15 . Februar 2013 erhielten 45 Patienten mit grenzwertig inoperablen Kopf-Hals-Tumoren nach gutem Ansprechen auf eine Induktionschemotherapie eine Radiochemotherapie . Das mediane Follow-up betrug 22 Monate . Die Schluckfunktion und die klinischen Date n wurden prospektiv mittels des EORTC-QLQ-C30-Fragebogens sowie klinisch evaluiert . Die Schluckstrukturen wurden retrospektiv in die Originalbestrahlungspläne der CT- Date nsätze eingezeichnet . Es wurden die Dosis-Volumen-Histogramme ( DVH ) für die Schluckstrukturen berechnet sowie jeweils Dmean , Dmax und die V50- bis V64-Werte bestimmt . Das Tumorvolumen und die Tumorinfiltration von Teilen des Schluckapparats wurden i m CT vor Induktionschemotherapie definiert . ErgebnisseInsgesamt 26 der 45 Patienten ( 57,8 % ) wiesen eine vollständige gute Schluckfunktion nach Radiochemotherapie auf . Weitere 12 Patienten ( 26,7 % ) konnten weiche , pürierte oder flüssige Kost zu sich nehmen . Die verbleibenden 7 ( 15,6 % ) Patienten wurden ausschließlich über die PEG ( „ percutaneous endoscopic gastrostomy “ ) ernährt . Die Schluckfunktion nach Radiochemotherapie wurde signifikant von der applizierten Dmean i m oberen Konstriktormuskel ( „ pharyngeal constrictor muscle “ , PCM ; p = 0,041 ) beeinflusst . Zudem konnte eine Korrelation der Spätdysphagie mit den Dosis-Volumen-Parametern i m oberen PCM und weichen Gaumen gezeigt werden , welche ab einer V60 i m weichen Gaumen ( p = 0,043 ) und ab einer V58 i m oberen PCM ( p = 0,012 ) signifikant waren . Von den getesteten klinischen und tumorspezifischen Faktoren hatte lediglich ein stattgehabter Alkoholabusus ( p = 0,024 ) einen Einfluss auf das posttherapeutische Schlucken nach TherapieSchlussfolgerungFast 50 % der Patienten können nach definitiver Radiochemotherapie aufgrund eines laryngopharyngealen Tumors nicht vollständig schlucken . Ein Grund hierfür scheint in der applizierten Dosis in Teilen des Schluckapparats zu liegen . Daher sollte bei ausgewählten Patienten zukünftig eine individuelle Optimierung der Zielvolumendefinition i m Kopf-Hals-Bereich zur Schonung des Schluckapparats erfolgen Background and purpose To compare early ( 3 and 6 month ) and later ( 12 and 24 month ) functional outcomes of stage III and IV ( M0 ) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal ( 3DCRT ) or intensity modulated radiotherapy ( IMRT ) . Patients and methods 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospect ively assessed at pre-treatment and 3 , 6 , 12 and 24 months post treatment . A st and ard functional outcomes protocol including performance status ( KPS , ECOG ) , 3 Performance Status scales for Head and Neck ( PSS-HN ) , the Royal Brisbane Hospital Outcome Measure for Swallowing ( RBHOMS ) , Voice H and icap Index-10 ( VHI-10 ) and self-rated xerostomia  were applied . Results Mean age at diagnosis was 59 years . The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients . Median follow up was 2.5 years for the second cohort . Concomitant therapy was used in 159 ( 79.5 % ) . Overall survival at 3 years was 75.6 % and 71.5 % for IMRT and 3DCRT cohorts respectively ( not significant ) . A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias . KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment . The 3 PSS-HN scales , Eating in Public ( p < 0.001 ) , Underst and ability of Speech ( p = 0.009 ) and Oral Diet Texture ( p = 0.002 ) and all showed significantly better outcomes in favor of IMRT . The RBHOMS showed a difference in favor of  IMRT  which appeared during 3 to 6 months ( p < 0.001 ) . The VHI-10 also showed a difference in favor of IMRT ( p = 0.015 ) . Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 Conclusions A prospect ively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early ( 3–6 months ) and later ( 12–24 months ) in the treatment of oropharyngeal carcinoma with equivalent survival . These data support the adoption of IMRT as the st and ard radiation treatment method for patients with stage III and IV ( M0 ) oropharyngeal squamous carcinoma .  KPS and ECOG may not be sensitive to oropharyngeal cancer patients ’ functional outcomes by treatment The aim of this study was to assess the effect of ( preventive ) rehabilitation on swallowing and mouth opening  after concomitant chemoradiotherapy ( CCRT ) . Forty-nine patients with advanced oral cavity , oropharynx , hypopharynx and larynx , or nasopharynx cancer treated with CCRT  were r and omized into a st and ard ( S ) or an experimental ( E ) preventive rehabilitation arm . Structured multidimensional assessment ( i.e. ,  videofluoroscopy , mouth-opening measurement , structured question naires ) was performed before and 10 weeks after CCRT . In both S and E arms , feasibility was good ( all patients could execute the exercises within a week ) and compliance was satisfactory ( mean days practice d per week was 4 ) . Nevertheless , mouth opening , oral intake , and weight decreased significantly . Compared to similar CCRT studies at our institute , however , fewer patients were still tube-dependent after CCRT . Furthermore , some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises . Patients in the E arm practice d significantly fewer days in total and per week , but they obtained results comparable to the S arm patients . Preventive rehabilitation ( regardless of the approach , i.e. , experimental or st and ard ) in head and neck cancer patients , despite advanced stage and burdensome treatment , is feasible , and compared with historical controls , it seems helpful in reducing the extent and /or severity of various functional short-term effects of CCRT This study evaluated and compared the Therabite Jaw Motion Rehabilitation System ( Therabite Corporation , Bryn Mawr , PA ) to tongue blades as a technique for maintaining and /or improving m and ibular range of motion in post-irradiated patients . Three groups of patients were evaluated and compared : 1 ) unassisted exercise , 2 ) mechanically assisted m and ibular mobilization with stacked tongue depressors combined with unassisted exercise , and 3 ) the Therabite System combined with unassisted exercise . The initial average maximum incisal opening ( MIO ) for the study population was 21.6 mm , and did not vary significantly among the groups . Measurements were recorded at 2-week intervals for 10 weeks . At week 6 and thereafter , the net increase in MIO of group 3 ( 13.6 mm [ + /- 1.6 mm ] ) was significantly greater than group 1 ( 6.0 mm [ + /- 1.8 mm ] ) and group 2 ( 4.4 mm [ + /- 2.1 mm ] ) ( P < .05 ) . The rate of improvement leveled after 4 week in group 1 and group 2 . However , the rate of gain in MIO in the Therabite group ( group 3 ) remained constant at 10 weeks . There was no statistical difference between groups 1 and 2 Concurrent chemoradiotherapy ( CCRT ) for advanced head and neck cancer ( HNC ) is associated with substantial early and late side effects , most notably regarding swallowing function , but also regarding voice quality and quality of life ( QoL ) . Despite increased awareness/knowledge on acute dysphagia in HNC survivors , long-term ( i.e. , beyond 5 years ) prospect ively collected data on objective and subjective treatment-induced functional outcomes ( and their impact on QoL ) still are scarce . The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients . The study was conducted as a r and omized controlled trial on preventive swallowing rehabilitation ( 2006–2008 ) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants . Multidimensional assessment of functional sequels was performed with videofluoroscopy , mouth opening measurements , Functional Oral Intake Scale , acoustic voice parameters , and ( study specific , SWAL-QoL , and VHI ) question naires . Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment . At a mean follow-up of 6.1 years most initial tumor- , and treatment-related problems remained similarly low to those observed after 2 years follow-up , except increased xerostomia ( 68 % ) and increased ( mild ) pain ( 32 % ) . Acoustic voice analysis showed less voicedness , increased fundamental frequency , and more vocal effort for the tumors located below the hyoid bone ( n = 12 ) , without recovery to baseline values . Patients ’ subjective vocal function ( VHI score ) was good . Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort , originating from preventive and continued post-treatment rehabilitation programs Abstract Background To investigate potential changes in perceptual , acoustic and patient-reported outcomes over 12 months for laryngeal cancer patients treated with radiotherapy .  Material and methods A total of 40 patients with Tis-T3 laryngeal cancer treated with curative intent by radiotherapy  were included in this prospect i ve longitudinal descriptive study . Patients were followed pre-radiotherapy , one month , six months and 12 months post-radiotherapy , where voice recordings and patient-reported outcome instruments ( European Organization for Research and Treatment of Cancer Quality -of-Life Question naire Core30 , Head and Neck35 , Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer ) were completed at each appointment . Perceptual analysis , using the Grade -Roughness-Breathiness-Asthenia-Strain scale and vocal fry parameters , and acoustic measures including harmonics-to-noise ratio ( HNR ) , jitter , shimmer and mean spoken fundamental frequency ( MSFF ) were produced from voice recordings . Results All patients presented with dysphonic voices pre-radiotherapy , where 95 % demonstrated some degree of vocal roughness . This variable improved significantly immediately post-radiotherapy , however , then deteriorated again between six and 12 months . Vocal fry also increased significantly at 12 months . Acoustic measures were abnormal pre- and post-treatment with no significant change noted except for MSFF , which lowered significantly by 12 months . Health-related quality of life ( HRQL ) deteriorated post-radiotherapy but returned to pretreatment levels by 12 months . Conclusion By 12 months , most perceptual , acoustic , patient-reported voice and HRQL outcomes for laryngeal cancer patients treated by radiotherapy had showed no significant improvements compared to pretreatment function . Further studies are required to investigate potential benefits of voice rehabilitation following radiotherapy OBJECTIVES /HYPOTHESIS The main goal of the current study was to comprehensively address the impact of chemoradiation and radiation techniques on toxicity , quality of life ( QoL ) , and functional outcome . STUDY DESIGN Retrospective analysis of toxicity and functional outcome and prospect i ve QoL assessment . METHODS From 1996 to 2010 , 176 consecutive patients with hypopharyngeal cancer ( HPC ) were treated with (chemo)radiotherapy . End points were acute and late toxicity , QoL assessment , and functional outcome using laryngoesophageal dysfunction-free survival ( LED-FS ) defined by the Laryngeal Preservation Consensus Panel . RESULTS Chemoradiation significantly increased grade 3 acute toxicity compared to radiotherapy alone ( 71 % vs. 55 % , P = .02 ) . The 3-year grade ≥2 late toxicity was 32 % . Intensity-modulated radiotherapy ( IMRT ) significantly reduced late toxicity compared to three-dimensional conformal radiotherapy ( 3DCRT ) ( 24 % vs. 44 % , P = .007 ) . Slight deterioration in QoL scores was observed on almost all scales , and was more pronounced in patients treated with chemoradiation , albeit not statistically significant except for xerostomia . Chemoradiation , compared to radiotherapy alone , improved LED-FS at 3 years ( 51 % vs. 24 % for the entire group and 83 % vs. 63 % for the 78 living patients at last follow-up , respectively [ P = .05 ] ) . CONCLUSIONS Compared to radiotherapy alone , chemoradiation significantly improved functional outcome , increased acute toxicity , but without significant increase in late radiation-induced side effects . Statistically significant deterioration in QoL scores was reported only for xerostomia . IMRT , compared to 3DCRT , reduced the incidence and severity of acute and late toxicity , thereby broadening the therapeutic window , and may allow dose escalation for further improvement of outcomes of laryngeal preservation protocol There is no st and ardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol , leaving institutions and individual speech- language pathologists ( SLPs ) to determine their own protocol s based on “ typical ” practice s or anecdotal evidence . To gain an underst and ing of current usual practice s , a national internet-based survey was developed and disseminated to SLPs who treat head and neck cancer ( HNC ) patients . From a r and om sample of 4,000 ASHA SID13 members , 1,931 fit the inclusion criteria , and 759 complete responses were recorded for a 39.3 % response rate . Results were analyzed by institution type as well as by individual clinical experience . While some interesting trends emerged from the data , a lack of uniformity and consensus regarding best practice s was apparent . This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population PURPOSE To prospect ively evaluate performance and quality of life ( QOL ) in advanced-stage head and neck cancer ( HNC ) patients on a curative-intent , concomitant-chemoradiotherapy ( CT/XRT ) ( twice-daily radiation , fluorouracil , hydroxyurea , and cisplatin ) regimen aim ed at improving locoregional control , survival , and QOL . PATIENTS AND METHODS Sixty-four patients were assessed before , during , and at 3-month intervals after treatment . St and ardized measures of QOL ( Functional Assessment of Cancer Therapy-Head and Neck ) , performance ( Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale ) , and patient-reported symptoms ( McMaster University Head and Neck Radiotherapy Question naire ) were administered . RESULTS Acute treatment toxicities were severe , with declines in virtually all QOL and functional domains . Marked improvement was seen by 12 months ; general functional and physical measures returned to baseline levels of good to excellent . Although up to a third of the patients continued to report problems with swallowing , hoarseness , and mouth pain , these difficulties were present in similar magnitudes before treatment . The following symptoms were more frequent at 12 months : dry mouth ( 58 % v 17 % ) , difficulties tasting ( 32 % v 8 % ) , and soft food diet ( 82 % v 42 % ) . Twelve-month diet was not related to pretreatment functioning , disease , treatment , or patient characteristics . Twelve-month QOL was best predicted by pretreatment QOL , with very little relationship to residual side effects or functional impairments . Small numbers of patients in four of the five disease sites precluded examination of outcome by site . CONCLUSION These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC . Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months . The persistent inability to eat a full range of foods warrants further attention and monitoring OBJECTIVE To assess the efficacy of prophylactic swallowing exercises on swallowing function in patients undergoing chemoradiation therapy ( CRT ) for head and neck cancer . DESIGN R and omized controlled trial . SETTING Tertiary care , academic medical center . PATIENTS Twenty-six patients with head and neck cancer receiving CRT . INTERVENTION Patients performed 5 targeted swallowing exercises throughout their CRT and participated in weekly swallowing therapy sessions to promote adherence and accurate technique . Controls had no prophylactic exercises and were referred for swallowing treatment after completion of CRT if indicated . MAIN OUTCOME MEASURES Swallowing function was assessed with the Functional Oral Intake Scale ( FOIS ) and the Performance Status Scale for Head and Neck Cancer Patients ( PSS-H&N ) at baseline , immediately after CRT , and at 3 , 6 , 9 , and 12 months after CRT . RESULTS There were no statistically significant differences in FOIS scores between intervention and control patients immediately after CRT ( immediately after CRT : intervention group median score , 3 [ range , 1 - 7 ] , vs median control score , 4 [ range , 1 - 6 ] ( P = .88 ) . However , intervention patients had significantly better scores at months 3 and 6 ( median 3-month intervention score , 7 [ range , 5 - 7 ] , vs median control score , 5 [ range , 3 - 7 ] [ P = .03 ] ; median 6-month intervention score , 7 [ range , 6 - 7 ] , vs median control score , 6 [ range , 3 - 7 ] [ P = .009 ] ) . There was no significant difference in scores at months 9 and 12 ( P = .24 and P = .93 , respectively ) . The same pattern between intervention and control patients was observed for scores on the PSS-H&N. CONCLUSIONS Patients who performed prophylactic swallowing exercises had improved swallowing function at 3 and 6 months after CRT but not immediately after CRT or at 9 and 12 months after CRT . The small sample size may have limited our ability to detect significant differences beyond 6 months of observation as well as additional significant differences in our study BACKGROUND The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by " risk-based " local therapy for locally-advanced squamous cell carcinoma of the head and neck ( SCCHN ) . METHODS Forty-seven patients ( stage IV ; ≥N2b ) were enrolled in a phase II trial . Baseline and 24-month functional measures included modified barium swallow ( MBS ) studies , oropharyngeal swallow efficiency ( OPSE ) , and the MD And erson Dysphagia Inventory ( MDADI ) . Functional status was assessed at 5 years . RESULTS Five-year overall survival ( OS ) was 89 % ( 95 % confidence interval [ CI ] , 81 % to 99 % ) . A nonsignificant 13 % average reduction in swallowing efficiency ( OPSE ) was observed at 24 months relative to baseline ( p = .191 ) . MDADI scores approximated baseline at 24 months . Among 42 long-term survivors ( median , 5.9 years ) , 3 patients ( 7.1 % ) had chronic dysphagia . The rate of final gastrostomy dependence was 4.8 % ( 2 of 42 ) . CONCLUSION Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN , mainly of oropharyngeal origin . MBS and MDADI scores found modest swallowing deterioration at 2 years , and chronic aspiration was uncommon in long-term survivors Abstract Background . Trismus is a common symptom related to the treatment of head and neck ( H&N ) cancer . To date there are few prospect i ve studies regarding the incidence of trismus and the patients ’ experience of trismus in daily life activities . The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact  on health-related quality of life ( HRQL ) , by evaluating the patients before and after oncological treatment . Material and methods . We used  the criteria for trismus of maximum interincisal opening ( MIO ) ≤ 35 mm  and measured the patients at several occasions before and after treatment during one year . The patients answered the HRQL question naires EORTC QLQ C30 , EORTC QLQ H&N 35 , Gothenburg Trismus Question naire ( GTQ ) and the  Hospital Anxiety and Depression Scale  ( HADS ) . Results . The incidence of trismus was 9 % pre-treatment and 28 % at the one-year follow-up post-treatment . The highest incidence , 38 % , was found six months post-treatment . Patients with tumours of the tonsils were most prone to develop trismus . Patients with trismus  reported greater HRQL impairments with regard to the GTQ domains ; mouth opening ( p < 0.001 ) , jaw-related problems ( p < 0.05 ) , eating limitations ( p < 0.05 ) and muscular tension ( p < 0.001 ) six months post-treatment . EORTC QLQ H&N 35 scores indicated clinical ly significantly more problems with dry mouth , swallowing and pain for patients with trismus , 6–12 months post-treatment . Furthermore , all patients reported pain , anxiety and depression pre- and post-treatment . Conclusion . The incidence of trismus in patients with H&N cancer is non-negligible . Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer . Further studies regarding symptomatic treatment of patients with trismus are highly warranted . The symptom-specific question naire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time PURPOSE Patients with intermediate-stage squamous cell carcinoma of the head and neck traditionally have been treated with initial surgical resection followed by radiotherapy ( RT ) alone or chemoradiotherapy . A previous study in this patient population reported a 91 % locoregional control rate and 65 % overall survival ( OS ) rate at 5 years , with chemoradiotherapy used as primary treatment . This study was undertaken to assess whether shortening treatment duration with hyperfractionated RT would be feasible and improve locoregional control , organ preservation , and progression-free survival . METHODS Eligible patients with stage II or III disease received fluorouracil , hydroxyurea , and RT  given twice daily on a week-on/week-off schedule . Quality -of-life scores were measured using three vali date d indexes . RESULTS All 53 patients enrolled are included in the analysis , with a median follow-up of 42 months ( range , 5 to 98 months ) . Grade 3 or 4 in-field mucositis was observed in 77 % and 9 % , respectively . No patients required surgical salvage at the primary tumor site ( pathological complete response rate , 100 % ) . The 3-year progression-free and OS rates are 67 % and 78 % , respectively . The 3-year disease-specific mortality rate is 7 % . At the time of analysis , 87 % of surviving patients do not require enteral feeding support . Quality -of-life and performance assessment indicated that , although acute treatment toxicities were severe , most patients returned to pretreatment function by 12 months . CONCLUSION Concurrent chemoradiotherapy with hyperfractionated RT is feasible in this patient population and yields high local control and cure rates . Compared with our historical control using once-daily fractionation , hyperfractionation is accompanied by increased acute in-field toxicity Concomitant chemoradiotherapy provides organ preservation for those patients with head and neck cancer . We report the results of a prospect i ve study that examined functional outcomes and quality of life ( QOL ) after chemoradiotherapy over the first 6 months post-treatment ( tx ) . Twenty-nine patients with head and neck cancer were treated with chemoradiotherapy .  All were seen baseline and 3 and 6 months post-tx . Assessment s included the performance status scale ( PSS ) , Karnofsky performance status scale , tongue strength , jaw opening , and saliva weight . QOL was patient-rated using the eating assessment tool ( EAT-10 ) , MD And erson dysphagia inventory , speech h and icap index ( SHI ) , and the EORTC H&N35 scale . Repeated- measures ANOVAs were used , with significance at p < 0.05 . PSS scores were significantly different across time points . Tongue strength , jaw range of motion ( ROM ) , and saliva weight were significantly lower at 3 and 6 months than at baseline . QOL was significantly worse after tx , although it improved by 6 months as rated with the EAT-10 and the SHI scores were significantly worse at 3 and 6 months . EORTC domains of swallowing , senses , speech , dry mouth , and sticky saliva were significantly worse at 3 and 6 months . Concomitant chemoradiotherapy for treatment of head and neck tumors can result in impaired performance outcomes and QOL over the first 6 months post-tx . However , performance status , tongue strength , jaw ROM , and eating QOL were only mildly impaired by 6 months post-tx . Saliva production and speech QOL remained significantly impaired at 6 months post-treatment . Current studies are examining outcomes at 12 and 24 months post-treatment to better predict outcomes over time in this population AIMS To investigate dosimetric predictors of  voice changes  after  whole-field intensity-modulated radiotherapy ( IMRT ) .  MATERIAL S AND METHODS Patients treated with whole-field IMRT for oropharyngeal/unknown primary tumours were selected for the present retrospective study having grossly uninvolved larynx at the time of radiotherapy and at least one follow-up visit .  Voice changes were prospect ively scored at each follow-up examination according to the Common Terminology Criteria for Adverse Events ( CTCAE ) v3.0 scale and self-reported by two items ( HN4 and HN10 ) of the Functional Assessment of Cancer Therapy-Head and Neck Scale ( FACT-HN ) question naire . Predictors of toxicity were investigated at logistic regression , including various patient and tumour characteristics , as well as individual dosimetric data . RESULTS With a median follow-up of 18 months ( range 3 - 46 months ) , peak CTCAE dysphonia was grade d as 2 in 13 patients ( 10.5 % ) , whereas 45 patients ( 36.3 % ) reported peak grade 0 - 1 voice changes according to FACT-HN4 . Communication ( FACT-HN10 ) was barely affected . At multivariate analysis , the mean laryngeal dose was an independent predictor of both grade 2 CTCAE dysphonia ( odds ratio = 1.10 , 95 % confidence interval 1.01 - 1.20 , P = 0.025 ) and grade 0 - 1 FACT-HN4 voice changes ( odds ratio = 1.11 , 95 % confidence interval 1.04 - 1.18 , P = 0.001 ) . Further stratification optimised by a receiver operating characteristic ( ROC ) analysis showed that , to minimise the risk of grade 0 - 1 FACT-HN4 voice changes , the mean dose to the larynx has to be kept ≤ 49.4 Gy . CONCLUSION Voice changes after whole-field IMRT are common , but mild , and are strictly correlated to the dose received by the uninvolved larynx ; in order to minimise the risk of side-effects , the mean dose to the larynx should be kept ≤ 50 Gy PURPOSE To present initial results of a clinical trial of intensity-modulated radiotherapy ( IMRT ) aim ing to spare the swallowing structures whose dysfunction after chemoradiation is a likely cause of dysphagia and aspiration , without compromising target doses . METHODS AND MATERIAL S This was a prospect i ve , longitudinal study of 36 patients with Stage III-IV oropharyngeal ( 31 ) or nasopharyngeal ( 5 ) cancer .  Definitive chemo-IMRT spared salivary gl and s and swallowing structures : pharyngeal constrictors ( PC ) , glottic and supraglottic larynx ( GSL ) , and esophagus . Lateral but not medial retropharyngeal nodes were considered at risk . Dysphagia endpoints included objective swallowing dysfunction ( videofluoroscopy ) , and both patient-reported and observer-rated scores . Correlations between doses and changes in these endpoints from pre-therapy to 3 months after therapy were assessed . RESULTS Significant correlations were observed between videofluoroscopy-based aspirations and the mean doses to the PC and GSL , as well as the partial volumes of these structures receiving 50 - 65 Gy ; the highest correlations were associated with doses to the superior PC ( p = 0.005 ) . All patients with aspirations received mean PC doses > 60 Gy or PC V(65 ) > 50 % , and GSL V(50 ) > 50 % . Reduced laryngeal elevation and epiglottic inversion were correlated with mean PC and GSL doses ( p < 0.01 ) . All 3 patients with strictures had PC V(70 ) > 50 % . Worsening patient-reported liquid swallowing was correlated with mean PC ( p = 0.05 ) and esophageal ( p = 0.02 ) doses . Only mean PC  doses were correlated with worsening patient-reported solid swallowing ( p = 0.04 ) and observer-rated swallowing scores ( p = 0.04 ) . CONCLUSIONS These dose-volume-effect relationships provide initial IMRT optimization goals and motivate further efforts to reduce swallowing structures doses to reduce dysphagia and aspiration PURPOSE To investigate the predictors of incidence and duration of xerostomia ( XT ) based on parotid gl and s ( PG ) , subm and ibular gl and s ( SMG ) , and both gl and s taken as a whole organ ( TG ) in head- and -neck cancer patients treated with intensity-modulated radiotherapy .  METHODS AND MATERIAL S A prospect i ve study was initiated in May 2003 . Sixty-three head- and -neck patients ( 44 with nasopharynx cancer ) were included in the analysis . Using the dose-volume histogram the PG , SMG , and TG mean doses were calculated . Unstimulated and stimulated salivary flow were measured and XT-related question naires were compiled before and at 3 , 6 , 12 , 18 , and 24 months after radiotherapy .  Salivary gl and toxicity was evaluated using the Radiation Therapy Oncology Group scale , and Grade > or=3 toxicity was used as the endpoint . The XT incidence was investigated according to descriptive statistics and univariate and multivariate analysis . The Bonferroni method was used for multiple comparison adjustment . RESULTS After a reduced flow at 3 months after radiotherapy , recovery of salivary flow was observed over time . Primary site and salivary gl and mean doses and volumes were identified in univariate analysis as prognostic factors . Multivariate analysis confirmed that TG mean dose ( p = 0.00066 ) and pretreatment stimulated salivary flow ( p = 0.00420 ) are independent factors for predicting XT . CONCLUSION The TG mean dose correlates with XT as assessed by Radiation Therapy Oncology Group criteria , salivary output , and XT-related question naires . Our results suggest that TG mean dose is a c and i date dose constraint for reducing XT , requiring considerably more validation in non-nasopharyngeal cancer patients Abstract Objective . This study aims to assess the effect of voice rehabilitation on health-related quality of life ( HRQL ) and communication experience for laryngeal cancer patients treated with radiotherapy .  Method . This prospect i ve r and omised controlled trial included 74 patients with Tis-T4 laryngeal cancer treated curatively by radiotherapy  , of which 37 constituted the intervention group receiving voice rehabilitation  and 37 patients as a control group .  Patients were followed at one and six months post-radiotherapy , with voice rehabilitation conducted between these time-points . Endpoints included patient reported outcomes , including HRQL as measured by European Organisation for Research and Treatment of Cancer ( EORTC ) Core30 ( C30 ) and Head & Neck35 ( H&N35 ) as well as communication function as measured by Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer ( S-SECEL ) . Results . The intervention group reported statistically significant improvements in communication experience as measured by S-SECEL environmental , attitudinal and total score domains compared to the control group . Similar improvements were seen in EORTC H&N35 Speech domain and the EORTC C30 domain Global quality of life . Moderate correlations were noted ( r = 0.51–0.59 ) between three of four S-SECEL domains and the EORTC domains Speech and Global quality of life . Conclusion . Laryngeal cancer patients treated with radiotherapy  who receive voice rehabilitation appear to experience beneficial effects on communication function and selected HRQL domains .  Voice rehabilitation following radiotherapy is recommended but further research investigating potential target groups and long-term effects is required BACKGROUND AND PURPOSE Prospect i ve assessment of dysphagia and trismus in  chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication . MATERIAL AND METHODS Assessment of 55 patients before , 10-weeks ( N=49 ) and 1-year post-treatment ( N=37 ) .  Calculation of dose-volume parameters for swallowing ( inferior ( IC ) , middle ( MC ) , and superior constrictors ( SC ) ) , and mastication structures ( e.g. masseter ) . Investigation of relationships between dose-parameters and endpoints for swallowing problems  ( videofluoroscopy-based laryngeal Penetration-Aspiration Scale ( PAS ) , and study -specific structured question naire ) and  limited mouth-opening ( measurements and question naire ) , taking into account baseline scores . RESULTS At 10-weeks , volume of IC receiving ≥60 Gy ( V60 ) and mean dose IC were significant predictors for PAS . One-year post-treatment , reported problems with swallowing solids were significantly related to masseter dose-parameters ( mean , V20 , V40 and V60 ) and an inverse relationship ( lower dose related to a higher probability ) was observed for V60 of the IC . Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks ( mean , V20 , and V40 ) . At 1-year , dose-parameters of all mastication structures were strong predictors for subjective mouth-opening problems ( mean , max , V20 , V40 , and V60 ) . CONCLUSIONS Dose-effect relationships exist for dysphagia and trismus . Therefore treatment plans should be optimized to avoid these side effects PURPOSE To investigate the impact of treatment-related toxicity on health-related quality of life ( HRQoL ) among patients with head and neck squamous cell carcinoma treated with radiotherapy either alone or in combination with chemotherapy or surgery .  PATIENTS AND METHODS The study sample was composed of 425 disease-free patients .  Toxicity was scored according to the European Organisation for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group ( RTOG ) late radiation-induced morbidity scoring system . HRQoL was assessed using the EORTC Quality of Life Question naire C30 . These assessment s took place at 6 , 12 , 18 , and 24 months after completion of radiotherapy . The analysis was performed using a multivariate analysis of variance . RESULTS Of the six RTOG scales investigated , two significantly affected self-reported HRQoL , salivary gl and ( RTOG(xerostomia ) ) and esophagus/pharynx ( RTOG(swallowing ) ) . Although RTOG(xerostomia ) was reported most frequently , HRQoL was most affected by RTOG(swallowing ) , particularly in the first 18 months after completion of radiotherapy . CONCLUSION Late radiation-induced toxicity , particularly RTOG(swallowing ) and RTOG(xerostomia ) , has a significant impact on the more general dimensions of HRQoL. These findings suggest that the development of new radiation-induced delivery techniques should not only focus on reduction of the dose to the salivary gl and s , but also on anatomic structures that are involved in swallowing AIMS To prospect ively analyze the objective voice quality before and after radiotherapy ( RT ) for early glottic cancer and to evaluate the role of different factors that may affect it . METHODS Patients with T1-T2N0M0 glottic cancer underwent  voice quality assessment before treatment and after radical RT . Post-RT voice quality was compared to the voice at diagnosis and the voice of healthy individuals used as controls . A comprehensive set of voice parameters were measured . The effects of age , smoking history , T stage , anterior commissure ( AC ) involvement , radiation dose , fractionation and volumes on pre-treatment and post-treatment voice quality were analyzed . RESULTS The voice quality data of 50 patients were analyzed . Following treatment , there was a significant improvement in the majority of measured parameters . However , perturbation and HNR remained inferior compared to controls . A history of smoking , AC involvement and larger RT volumes result ed in poorer voice parameters following RT . There was no significant impact of age alone . T2 tumors had an inferior voice quality before treatment , but did not remain inferior following RT . Hypofractionated RT did not show any negative impact . CONCLUSIONS There is a considerable improvement of voice quality following RT . Several factors may have specific effects on pre-treatment and post-treatment voice Although 50–70 % of head and neck cancer patients in India receive radiotherapy ( RT ) , radiation-related acute and late morbidities and their impact on quality of life ( QOL ) are infrequently reported . Acute and late radiation morbidities and QOL were assessed in a prospect i ve longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation .  Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa ( 66.4 % ) , salivary gl and ( 84 % ) , and oesophagus ( 53 % ) . These morbidities led to an increase in the symptom scores of appetite loss ( 76.46 ) , fatigue ( 65.75 ) and pain ( 44.77 ) . This increase in the symptom scores consequently led to a significant decline in physical , social and emotional functioning as well as global health status score during the course of RT ( p < 0.001 ) . Scores improved after 1 month of RT but did not reach the pre-RT value . Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status , weight loss , stage and site of disease OBJECTIVE Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy . The quality of voice achieved with these treatments has not been compared in a r and omized trial . METHODS AND MATERIAL S Male patients with carcinoma limited to 1 mobile vocal cord ( T1aN0M0 ) were r and omly assigned to receive either  laser surgery ( n=32 ) or  external beam radiation therapy ( n=28 ) . Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia . External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks . Voice quality was assessed at baseline and 6 and 24 months after treatment . The main outcome measures were expert-rated voice quality on a grade , roughness , breathiness , asthenia , and strain ( GRBAS ) scale , videolaryngostroboscopic findings , and the patients ' self-rated voice quality and its impact on activities of daily living . RESULTS Overall voice quality between the groups was rated similar , but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy . Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment . Three patients in each group had local cancer recurrence within 2 years from r and omization . CONCLUSIONS Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are dem and ing . Overall voice quality was similar in both treatment groups , however , indicating a need for careful consideration of patient-related factors in the choice of a treatment option BACKGROUND We report the results of a multicenter r and omized phase III study , assessing quality of life ( QOL ) in intra-arterial ( IA ) versus st and ard intravenous ( IV ) chemoradiation in advanced head and neck cancer . METHODS Two hundred seven patients with inoperable stage IV disease-152 men and 55 women ; mean age , 55 years-were included in this study . The patients were treated with st and ard radiotherapy with 4 weekly IA or 3 weekly IV cisplatin infusions . The QOL assessment s carried out were EORTC-C30 , H&N35 , and trial-specific question naires . RESULTS Overall QOL deteriorated in all patients during treatment , is gradually improving over 1 year . IA patients showed significantly less nausea and vomiting at week 7 ( p < .001 ) . IV patients were significantly more fatigued ( p < .006 ) . At 1 year , no significant difference in tube feeding was found . Voice quality slightly exceeded the pretreatment values at 1 year . Forty-two of 62 employed patients returned to work . CONCLUSION During treatment , significantly fewer problems with nausea and vomiting occurred in IA than in IV patients . Both groups showed improved voicing and oral intake during follow-up , often exceeding pretreatment values at 1 year BACKGROUND AND PURPOSE Morbidity is an important issue in cancer research . The observer-based toxicity scoring system used by DAHANCA ( the Danish head and neck cancer study group ) has proved itself sensitive to differences in toxicity in a large r and omised study , but like other toxicity scoring systems it has not been formally vali date d. Conversely , the EORTC quality of life question naire ( QLQ ) has been vali date d as a tool for collecting information about the consequences of disease and treatment on the well being of cancer patients . The purpose of this study was to examine the relationship between the two methods of side effect recording . PATIENTS AND METHODS One hundred and sixteen recurrence free patients with laryngeal ( n=44 ) , pharyngeal ( n=34 ) and oral cavity ( n=38 ) cancer attending follow-up after radiotherapy ( n=83 ) or surgery ( n=33 ) completed EORTC C30  , the core question naire concerning general symptoms and function and EORTC H&N35 the head and neck specific question naire . The attending physicians in the follow-up clinic evaluated and recorded DAHANCA  toxicity scores on the same patients . RESULTS The DAHANCA  toxicity scoring system  and the EORTC QLQ correlated with several clinical endpoints . The conceptually similar endpoints of the two methods correlated significantly . The objective endpoints of the DAHANCA scoring system were only correlated with quality of life endpoints to a very low degree . The DAHANCA  toxicity scores had a low sensitivity ( 0.48 - 0.74 ) in detecting equivalent subjective complaints from the question naires and the observer-based scoring system severely underestimated patient complaints . A specific patient group where the DAHANCA score had a higher tendency to fail could not be detected . CONCLUSION The DAHANCA toxicity score is an effective instrument in assessing objective treatment induced toxicity in head and neck cancer patients but insensitive and non-specific with regard to patient assessed subjective endpoints . This weakness seems inherent in an observer-based scoring system , and will probably also apply to newer ones like CTCAE 3.0 The European Organization for Research and Treatment of Cancer ( EORTC ) 24954 phase 3 r and omized clinical trial compared 2 schemes of combined chemotherapy for patients with resectable cancers of the hypopharynx and larynx :  sequential induction chemotherapy and radiotherapy versus alternating chemoradiotherapy . The current study reports detailed effects of both treatment arms on health‐related quality of life ( HRQOL ) and symptoms PURPOSE To report , from a retrospective analysis of prospect ively collected data , on the feasibility , outcome , toxicity , and voice-h and icap index ( VHI ) of patients with T1a glottic cancer treated by a novel intensity modulated radiation therapy technique developed at our institution to treat only the involved vocal cord : single vocal cord irradiation ( SVCI ) .  METHODS AND MATERIAL S Thirty patients with T1a glottic cancer were treated by means of SVCI .  Dose prescription was set to 16 × 3.63 Gy ( total dose 58.08 Gy ) . The clinical target volume was the entire vocal cord . Setup verification was done by means of an online correction protocol using cone beam computed tomography . Data for voice quality assessment were collected prospect ively at baseline , end of treatment , and 4 , 6 , and 12 weeks and 6 , 12 , and 18 months after treatment using VHI question naires . RESULTS After a median follow-up of 30 months ( range , 7 - 50 months ) , the 2-year local control and overall survival rates were 100 % and 90 % because no single local recurrence was reported and 3 patients died because of comorbidity . All patients have completed the intended treatment schedule ; no treatment interruptions and no grade 3 acute toxicity were reported . Grade 2 acute dermatitis or dysphagia was reported in only 5 patients ( 17 % ) . No serious late toxicity was reported ; only 1 patient developed temporary grade 2 laryngeal edema , and responded to a short-course of corticosteroid . The VHI improved significantly , from 33.5 at baseline to 9.5 and 10 at 6 weeks and 18 months , respectively ( P<.001 ) . The control group , treated to the whole larynx , had comparable local control rates ( 92.2 % vs 100 % , P=.24 ) but more acute toxicity ( 66 % vs 17 % , P<.0001 ) and higher VHI scores ( 23.8 and 16.7 at 6 weeks and 18 months , respectively , P<.0001 ) . CONCLUSION Single vocal cord irradiation is feasible and result ed in maximal local control rate at 2 years . The deterioration in VHI scores was slight and temporary and subsequently improved to normal levels . Long-term follow-up is needed to consoli date these promising results The purpose of the study was to identify predictors of weight loss during radiotherapy ( RT ) in patients with stage I or II head and neck ( HN ) cancer PURPOSE To conduct prospect i ve electroglottographic analyses of voice outcomes after radical chemoradiotherapy for locally advanced laryngopharyngeal cancers and to compare them with patients who have undergone total laryngectomy ( TL ) .  PATIENTS AND METHODS Twenty-one patients ( 19 male , 2 female , median age [ range ] 65 [ 50 - 85 ] years ) with Stage III/IV laryngopharyngeal cancer received induction chemotherapy followed by radical chemoradiotherapy . Electroglottography , using the sustained vowel /i/ and connected speech , was performed before treatment and 1 , 6 , and 12 months after treatment . In addition , single voice recordings were taken from 21 patients ( 16 male , 5 female , aged 65 [ 50 - 84 ] years ) who had undergone TL and surgical voice restoration and from 21 normal controls ( 18 male , 3 female , aged 65 [ 33 - 80 ] years ) . RESULTS Before treatment the vocal measures for the chemoradiotherapy patients were significantly different from normal controls in jitter ( p = 0.02 ) , maximum phonation time ( MPT ) ( p = 0.001 ) , and words per minute ( WPM ) ( p = 0.01 ) . At 12 months after treatment MPT and WPM had normalized , but jitter and normalized noise energy were significantly worse than in normal controls . Comparison of voice outcomes at 12 months for chemoradiotherapy patients revealed superiority over the TL group in all parameters except MPT ( 18.2 s vs. 10.4 s , p = 0.06 ) . Analysis of the recovery of voice up to 12 months after treatment revealed progressive improvement in most electroglottographic measures . CONCLUSIONS This prospect i ve study demonstrates significantly better outcome for patients treated with chemoradiotherapy as compared with TL . Progressive normalization of many voice parameters occurs over the 12 months following chemoradiotherapy PURPOSE To test the hypothesis that radiation dose to key sites in the upper aerodigestive tract is associated with long-term functional outcome after (chemo)radiotherapy for head- and -neck cancers . METHODS AND MATERIAL S This study examined the outcome for 27 patients treated with intensity-modulated radiotherapy for definitive management of their head- and -neck cancer who were disease free for at least 1 year after treatment .  Head- and -neck cancer-specific quality of life ( QoL ) was assessed before treatment and at 1 year after treatment . Type of diet tolerated , presence of a feeding tube , and degree of weight loss 1 year after treatment were also used as outcome measures . Radiation doses delivered to various points along the upper aerodigestive tract , including base of tongue , lateral pharyngeal walls , and laryngeal structures , were determined from each treatment plan . Radiation doses for each of these points were tested for correlation with outcome measures . RESULTS Higher doses delivered to the aryepiglottic folds , false vocal cords , and lateral pharyngeal walls near the false cords correlated with a more restrictive diet , and higher doses to the aryepiglottic folds correlated with greater weight loss ( p < 0.05 ) 1 year after therapy . Better posttreatment speech QoL scores were associated with lower doses delivered to structures within and surrounding the larynx . CONCLUSION Our data show an inverse relationship between radiation dose delivered to laryngeal structures and speech and diet and QoL outcomes after definitive (chemo)radiation treatment . These findings suggest that efforts to deliver lower doses to laryngeal structures may improve outcomes after definitive (chemo)radiation therapy BACKGROUND This is the first prospect i ve study to use instrumental and both clinician- and client-rated auditory-perceptual measures to examine voice and voice-related quality of life changes in patients after curative radiotherapy for early glottic cancer . METHOD Thirty patients undergoing curative radiotherapy treatment for early glottic cancer completed the following : 3 voice tasks for acoustic , aerodynamic , and auditory-perceptual voice measures ( therapist-rated ) ; a  patient self-report rating of voice quality ;  and a  voice-related quality of life assessment  before and 12 months after radiotherapy . RESULTS Patients ' perceptions of their voice quality and their voice-related quality of life significantly improved posttreatment , as did acoustic , aerodynamic , and auditory-perceptual voice measures . Mean speaking fundamental frequency did not change significantly , although breathiness and strain in the voice recordings were demonstrably reduced . CONCLUSION In describing postradiotherapy voices in this study , pertinent measures of voice outcomes have been established , setting the benchmark for comparison in future cohort studies OBJECTIVES Perceptual judgments and patients ' perception of voice and speech after concurrent chemoradiotherapy ( CCRT ) for advanced head and neck cancer . STUDY DESIGN Prospect i ve clinical trial . METHODS A st and ard Dutch text and a diadochokinetic task were recorded . Expert listeners rated voice and speech quality ( based on Grade , Roughness , Breathiness , Asthenia , and Strain ) , articulation ( overall , [ p ] , [ t ] , [ k ] ) , and comparative mean opinion scores of voice and speech at three assessment points calculated . A structured study -specific question naire evaluated patients ' perception pretreatment ( N=55 ) , at 10-week ( N=49 ) and 1-year posttreatment ( N=37 ) . RESULTS At 10 weeks , perceptual voice quality is significantly affected . The parameters overall voice quality ( mean , -0.24 ; P=0.008 ) , strain ( mean , -0.12 ; P=0.012 ) , nasality ( mean , -0.08 ; P=0.009 ) , roughness ( mean , -0.22 ; P=0.001 ) , and pitch ( mean , -0.03 ; P=0.041 ) improved over time but not beyond baseline levels , except for asthenia at 1-year posttreatment ( voice is less asthenic than at baseline ; mean , + 0.20 ; P=0.03 ) . Perceptual analyses of articulation showed no significant differences . Patients judge their voice quality as good ( score , 18/20 ) at all assessment points , but at 1-year posttreatment , most of them ( 70 % ) judge their " voice not as it used to be . " In the 1-year versus 10-week posttreatment comparison , the larynx-hypopharynx tumor group was more strained , whereas nonlarynx tumor voices were judged less strained ( mean , -0.33 and + 0.07 , respectively ; P=0.031 ) . Patients ' perceived changes in voice and speech quality at 10-week post- versus pretreatment correlate weakly with expert judgments . CONCLUSION Overall , perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment . However , at that assessment point , most patients still perceive their voice as different from baseline BACKGROUND This prospect i ve study evaluated the impact of patient demographics , tumor characteristics , and radiotherapy treatment on swallowing before and after radiotherapy or chemoradiotherapy . METHODS Eighty-one patients with head and neck cancer were examined using videofluoroscopy swallowing studies ( VFSS ) before treatment and again at 3 and 6 months after treatment . RESULTS Swallowing was best at baseline , significantly worse 3 months posttreatment , and improved by 6 months posttreatment . Worse swallowing was associated with : living in rural areas ; ex-heavy alcohol consumption ; hypopharyngeal tumor site ; large ( particularly T4 ) tumors ; nonconformal radiotherapy ; bilateral radiation to the pharynx ; and longer radiotherapy fields . Through the use of multiple regression analysis , previous swallowing was determined to be the most common predictor of swallowing outcomes , followed by T classification , alcohol history , and radiotherapy technique . CONCLUSIONS The pretreatment and treatment factors that influenced swallowing in this cohort should be considered when planning treatment , in discussing potential side effects with patients , and when developing and testing future treatment techniques
Introduction .
Patients with head and neck cancer suffer from various impairments due to the primary illness , as well as secondary consequences of the oncological treatment .
This systematic review describes the effects of radiotherapy and /or chemotherapy on the functions of the upper aerodigestive tract in patients with head and neck cancer .