Dysphagia After Radiotherapy for Head and Neck Cancer: Etiology, Clinical Presentation, and Efficacy of Current Treatments

After radiation therapy (RT) or chemoradiation (CRT) therapy for head and neck cancer, some patients develop significant swallowing problems. This complication is thought to be a result of radiation induced damage and chronic alteration of tissues whereby the body reacts to the radiation by producing fibrosis. In some persons, this healing process seems to go awry, thus causing excess fibrosis and dysphagia. The major problem faced by patients with dysphagia is stiffness of tissue and underlying muscle weakness, causing reduced bolus clearance; hence, food is much more problematic than liquids. In fact, aspiration is rare unless the dysphagia is severe. While compensatory treatment for dysphagia post C/RT is helpful, it is not rehabilitative. More permanent rehabilitative approaches use exercise regiments along with stretching. Massage, lymphedema therapy and electrical stimulation are sensory based or externally based treatments that also are employed, but less frequently. Unfortunately, the efficacy of most treatment approaches is limited, and randomized clinical trials urgently are needed to guide clinicians who work with this population.