Effects of Lingual Effort on Swallow Pressures Following Radiation Treatment

2015 ◽  
Vol 58 (3) ◽  
pp. 687-697 ◽  
Author(s):  
Kerry Lenius ◽  
Julie Stierwalt ◽  
Leonard L. LaPointe ◽  
Michelle Bourgeois ◽  
Giselle Carnaby ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Radiation Treatment ◽  
External Beam Radiotherapy ◽  
Upper Esophageal Sphincter ◽  
Oral Tongue ◽  
Esophageal Sphincter ◽  
Therapeutic Activities ◽  
Swallow Function

Purpose This article investigated the effects of increased oral lingual pressure on pharyngeal pressures during swallowing in patients who have undergone radiotherapy for head and neck cancer. It was hypothesized that increased oral lingual pressure would result in increased pharyngeal pressures. Method A within-subject experimental design was used with 20 participants who were status post external beam radiotherapy for head and neck cancer. Participants completed typical swallows and swallows with increased lingual force during manofluoroscopic swallow studies. The swallow condition order was randomized across participants. Results Manometric data revealed significant differences in swallow pressure by condition at the base of tongue and upper esophageal sphincter sensor locations without significant pressure differences in the lower pharynx. The effortful lingual swallows resulted in higher mean pressures at all locations. Conclusions The results of this study suggest that use of a maneuver designed to increase oral tongue effort can also increase pharyngeal tongue base pressure. Therefore, therapeutic activities used to generate greater pressure of the oral tongue may also alter pharyngeal response. Further research is needed to determine the direct clinical effect on swallow function for individuals with head and neck cancer.

scholarly journals Prospective assessment of DCE-MRI parameters associated with advanced mandibular osteoradionecrosis after IMRT for head and neck cancer

2019 ◽  
Author(s):  
◽  
Abdallah S. R. Mohamed ◽  
Renjie He ◽  
Yao Ding ◽  
Jihong Wang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Radiation Treatment ◽  
External Beam Radiotherapy ◽  
Mirror Image ◽  
Self Control ◽  
Anatomical Location ◽  
Curative Intent ◽  
Dce Mri

AbstractPurposeWe aim to characterize the quantitative DCE-MRI parameters associated with advanced mandibular osteoradionecrosis (ORN) compared to the contralateral normal mandible.Experimental DesignPatients with the diagnosis of advanced ORN after curative-intent radiation treatment of head and neck cancer were prospectively enrolled after institutional-review board approval and study-specific informed consent. Eligibility criteria included; age>18 years, pathological evidence of head and neck malignancy with history of curative-intent external beam radiotherapy; patients with clinically confirmed high-grade ORN requiring surgical intervention; and no contraindications to MRI. The DCE-MRI acquisition consisted of a variable flip angle T1 mapping sequence and a multi-phase 3D FSPGR sequence. Quantitative maps generated with the Tofts and extended Tofts pharmacokinetic model were used for analysis. Motion correction was applied. Manual segmentation of advanced ORN 3-D volume was done using anatomical sequences (T1, T2, and T1+contrast) to create ORN volumes of interest (ORN-VOIs).Subsequently, normal mandibular VOIs were segmented on the contralateral healthy mandible of similar volume and anatomical location (i.e., mirror image) to create self-control VOIs. Finally, anatomical sequences were co-registered to DCE sequences, and contours were propagated to the respective quantitative parameter maps.ResultsThirty patients were included. Median age at diagnosis was 58 years (range 19-78), and 83% were men. The site of tumor origin was in the oropharynx, oral cavity, salivary glands, and nasopharynx in 13, 9, 6, and 2 patients, respectively. The median time to ORN development after completion of IMRT was 38 months (range 6-184). There were statistically significant higher Ktrans and Ve values in ORN-VOIs compared with controls (0.23 vs. 0.07 min−1, and 0.34 vs. 0.15, p <0.0001 for both) using matched pairs analysis. The average relative increase of Ktrans in ORN-VOIs was 3.2 folds healthy mandibular control VOIs. Moreover, the corresponding rise of Ve in ORN-VOIs was 2.7 folds higher than the controls. Using combined Ktrans and Ve parameters, 27 patients (90%) had at least a 200% increase of either of the studied parameters in the ORN-VOIs compared with their healthy mandible control VOIs.ConclusionOur results confirm there is a quantitatively significant higher degree of leakiness in the mandibular vasculature as measured using DCE-MRI parameters of areas affected with an advanced grade of ORN versus healthy mandible. We were able to measure significant increases in quantitative metrics compared to values from the non-ORN mandibular bone. Further efforts are ongoing to validate these findings to enable the use of these DCE-MRI parameter thresholds for the early detection of subclinical cases of ORN.

scholarly journals Development of a Web-Based Supportive Care Program for Patients With Head and Neck Cancer

2020 ◽  
Vol 10 ◽  
Author(s):  
Carolyn Y. Fang ◽  
Thomas J. Galloway ◽  
Brian L. Egleston ◽  
Jessica R. Bauman ◽  
Barbara Ebersole ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Supportive Care ◽  
Head And Neck ◽  
Neck Cancer ◽  
Self Efficacy ◽  
Radiation Treatment ◽  
Web Based ◽  
Coping With Cancer ◽  
Wide Range ◽  
The Web

Patients undergoing radiation treatment for head and neck cancer experience significant side-effects that can impact a wide range of daily activities. Patients often report receiving insufficient information during and after treatment, which could impede rehabilitation efforts; they may also encounter practical and logistical barriers to receipt of supportive care. Thus, we developed a web-based program, My Journey Ahead, to provide information and strategies for managing symptom-focused concerns, which may be easily accessed from the patient’s home. The purpose of this study was to evaluate patient acceptability and satisfaction with the My Journey Ahead program. In Phase 1, five patients with head and neck squamous cell carcinoma (HNSCC) reviewed the web-based program and provided initial feedback, which informed program modifications. In Phase 2, 55 patients were recruited to evaluate the program. Patient assessments were obtained prior to and after use of the web-based program, and included measures of psychological distress, self-efficacy in coping with cancer-related issues, and satisfaction with the website. Among the 55 patients enrolled, 44 logged in and viewed the web-based program. Participants reported high levels of satisfaction with the information received, and indicated that the website was interesting and easy to use. Older age and higher levels of self-efficacy in coping were each associated with higher levels of satisfaction with the website. In summary, the web-based program was well-received by patients, the majority of whom found it to be informative and useful. An easy-to-use web-based program, particularly for older patients who may have difficulty locating reliable evidence-based information on the internet, may be helpful in addressing survivors’ needs in symptom management and coping with cancer.Clinical Trial Registrationhttps://clinicaltrials.gov/, NCT02442336

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