Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer

Objective: To determine whether laryngeal penetration and aspiration in oropharyngeal cancer survivors differ by treatment group. Design: Cross-sectional study of patients with stage III or IV oropharyngeal squamous cell carcinoma who were at least 12 months removed from combined modality therapy and clinically free of disease. Subjects: Potential subjects were stratified by tumor site and tumor T stage to achieve a similar comparison between chemoradiotherapy (n = 10) and surgery/radiotherapy (n =11) groups. Validated instruments used to evaluate swallowing included the Penetration-Aspiration Scale and the M. D. Anderson Dysphagia Inventory. Results: Patients with oropharyngeal cancer treated with chemoradio therapy demonstrated greater airway scores than those treated with surgery and radiotherapy on 5-mL (P=.02), 10-mL (P=.04), and 20-mL (P=.04) liquid barium swallows. Also, the oropharyngeal chemoradiotherapy group had better self-perceived swallowing ability than the surgery-radiotherapy group on the basis of the M. D. Anderson Dysphagia Inventory (P=.02). Conclusion: The present study suggests that patients with oropharyngeal cancer who successfully complete chemoradiotherapy protocols without surgical salvage retain greater airway protection during swallowing and better swallowing-related quality of life than patients treated with primary surgery and radiotherapy.