- Long-term oropharyngeal and laryngeal function in patients with advanced head and neck cancer
L. van der Molen
- Award date
- 8 July 2016
- Number of pages
- Document type
- PhD thesis
- Faculty of Dentistry (ACTA)
Radiotherapy or combined chemoradiotherapy (CRT) regimens are increasingly used as primary treatment for patients with advanced head and neck cancer (HNC). Unfortunately, these organ-preserving protocols are associated with substantial adverse functional events. Previous research has shown that preventive swallowing rehabilitation can significantly reduce the functional disabilities. This thesis focuses on oropharyngeal and laryngeal function following CRT for advanced HNC, including long-term results of cross-sectional cohort studies, and prospectively studied treatment strategies for chronic, therapy-refractory dysfunction.
In Part 1 a HNC patient population previously treated with concurrent CRT (either IMRT or conventional radiotherapy) was studied at 10-years post-treatment. Severe functional disorders and related morbidity problems were common. A patient population that was previously also treated with preventive rehabilitation showed fewer problems with either swallowing or voice quality at 6-years post-treatment. The surviving patients treated with IMRT showed significantly less impairments compared to those treated with conventional radiotherapy.
Part 2 describes non-surgical or minimal invasive treatment strategies for oropharyngeal and laryngeal dysfunction. The feasibility and effectiveness of strengthening exercises with a dedicated swallowing exercise aid was subsequently studied in senior healthy subjects and in HNC patients with chronic dysphagia. Some objective and subjective effects of progressive load on suprahyoid muscle strength and swallowing function were demonstrated. Also the feasibility and potential value of an experimental treatment (lipofilling) was prospectively studied in patients with post-treatment oropharyngeal dysfunction. The procedure seemed safe and in selected cases of potential value. Further improvement is expected from earlier application and from a combination of both new methods.
- Research conducted at: Universiteit van Amsterdam