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The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics

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Abstract

Radiation oncologists have focused on the pharyngeal constrictors as the primary muscles of concern for dysphagia. However, our prior investigations have demonstrated that radiation dose to the geniohyoid rather than the constrictor muscles was more closely related to penetration aspiration scores (PAS). We examined the relationship between (1) radiation dose and swallowing temporal kinematics, and (2) between PAS and swallowing kinematics in these patients. Videofluoroscopic swallowing studies of 41 patients following radiation therapy for oropharyngeal cancer were analyzed for thin liquid boluses. Timing measures included duration of laryngeal vestibule closure (DLVC), duration to maximum hyoid elevation (DTMHE), duration to cricopharyngeal opening (DTCPO), and pharyngeal transit time (PTT). PAS was extracted for each swallow and considered normal if ≤2. As minimum and mean dose to the geniohyoid increased, DTMHE, DTCPO, and PTT increased. Worse PA scores were most strongly correlated with radiation dose received by geniohyoid (r = 0.445, p < 0.0001). Mean DLVC varied according to PAS group (normal PAS mean = 0.67 s, abnormal PAS mean = 0.13 s; p < 0.001). Similarly, DTCPO was significantly different based upon PAS (normal PAS mean = 0.22 s, abnormal PAS mean = 0.37 s, p = 0.016). As PAS increased, DTPCO and PTT increased (r = 0.208, p = 0.04; r = 0.204, p = 0.043). A negative correlation was noted between PAS and DLVC (r = −0.375, p = 0.001). Higher doses of radiation to the geniohyoid muscles are associated with increased severity of dysphagia as measured through both kinematics and PAS. Consideration of dose to the geniohyoid should be considered when planning radiation.

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Conflict of interest

The authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA

    Heather M. Starmer

  2. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA

    Harry Quon, Rachit Kumar & Sara Alcorn

  3. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Emi Murano & Bronwyn Jones

  4. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA

    Ianessa Humbert

  5. Department of Otolaryngology - Head and Neck Surgery, Stanford University, 900 Blake Wilbur Drive Suite 3073, Stanford, CA, 94305, USA

    Heather M. Starmer

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  1. Heather M. Starmer
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  2. Harry Quon
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  3. Rachit Kumar
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  4. Sara Alcorn
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  5. Emi Murano
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  6. Bronwyn Jones
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  7. Ianessa Humbert
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Correspondence to Heather M. Starmer.

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Starmer, H.M., Quon, H., Kumar, R. et al. The Effect of Radiation Dose on Swallowing: Evaluation of Aspiration and Kinematics. Dysphagia 30, 430–437 (2015). https://doi.org/10.1007/s00455-015-9618-1

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  • DOI: https://doi.org/10.1007/s00455-015-9618-1

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