A Retrospective Review of Swallowing Outcomes for Oropharyngeal and Laryngeal Cancer Patients After Chemoradiation: A Single Institution Report

To collect our institutional experience and assess dysphagia prior to, during, and after chemoradiation for oropharyngeal and laryngeal cancer patients. This data can be used for future comparison with patients treated with newer radiation therapy techniques that are designed to decrease cumulative dose to swallowing structures. Methods: A retrospective review of oropharyngeal and laryngeal cancer patients treated with chemoradiation with curative intent at the University of Iowa Healthcare (UIHC) from 2019-2022. Manual chart review identified baseline patient data, tumor characterization, and the following dysphagia measures: EAT-10, Penetration and Aspiration Scale (PAS), and oropharyngeal motility study (OPMS). Linear mixed effects regression was used to estimate the rate of change in mean scores from baseline, and to assess differences in baseline scores and the rate of change across disease and clinical characteristics. Results: Of the 109 patients, 89 patients were treated for oropharyngeal cancer and 20 were treated for laryngeal cancer. There was a statistically significant increase in the mean EAT-10 scores from baseline to initial follow-up (10.14 vs. 13.27, p=0.03) for all patients. The rate of change in EAT-10 scores also significantly differed (p<0.01) based on whether the baseline EAT-10 assessment was prior, during, or after radiation therapy. Mean PAS scores were significantly greater at initial follow-up compared to baseline (3.94 vs. 3.14, p=0.04) for all patients. Mean baseline PAS scores significantly differed between larynx and oropharynx patients (4.63 vs. 2.81, p=0.01). There were no statistically significant differences between laryngeal and oropharyngeal patients in OPMS assessment of swallowing impairment. Patient-reported dysphagia via EAT-10 scores generally mirrored clinician assessments via PAS and OPMS. Conclusions: Our analysis indicates that dysphagia worsens in oropharyngeal and laryngeal cancer patients in the months immediately following chemoradiation, with more self-perceived issues with swallowing and higher degrees of penetration and aspiration. Laryngeal cancer patients have higher degrees of penetration and aspiration than oropharyngeal cancer patients at baseline. Future prospective studies are warranted to evaluate swallowing outcomes in patients treated with newer radiation techniques.