基于中文版MDADI的康复治疗对帕金森病合并吞咽困难患者康复的影响

目的:探讨基于中文版安德森吞咽困难量表(MDADI)的康复治疗对帕金森病合并吞咽困难患者营养和神经功能康复的影响。方法:将帕金森病合并吞咽困难患者72例随机分为研究组和对照组各36例。对照组常规行饮食干预,研究组根据MDADI总量表得分进行饮食干预。比较2组治疗前后营养指标水平、吞咽困难分级及Barthel指数。结果:治疗2周后,2组吞咽困难程度均较治疗前明显改善(P0.05),且观察组优于对照组(P0.05)。治疗后,2组血清血红蛋白、白蛋白水平、血脂水平较治疗前均明显提高(均P0.05),且研究组高于对照组(均P0.05)。治疗后,2组Barthel指数均较治疗前明显提高(均P0.05),且观察组高于对照组(P0.05)。结论:基于中文版MDADI的饮食干预有助于改善帕金森病合并吞咽困难的营养状况和神经功能。     

Improvement in Dysphagia Outcomes Following Clinical Target Volume Reduction in the De-ESCALaTE Study

AimsThe De-ESCALaTE study showed an overall survival advantage for the administration of synchronous cisplatin chemotherapy with radiotherapy in low-risk oropharyngeal cancer when compared with synchronous cetuximab. During the trial, a radiotherapy quality assurance protocol amendment permitted centres to swap from the original radiotherapy contouring protocol (incorporating the whole oropharynx into the high-dose clinical target volume (CTV); anatomical protocol) to a protocol that incorporated the gross tumour volume with a 10 mm margin into the CTV (volumetric protocol). The purpose of this study was to examine both toxicity and tumour control related to this protocol amendment.Materials and methodsOverall survival and recurrence at 2 years were used to compare tumour control in the two contouring cohorts. For toxicity, the cohorts were compared by both the number of severe (grades 3–5) and all grades acute and late toxicities. In addition, quality of life and swallowing were compared using EORTC-C30 and MD Anderson Dysphagia Inventory, respectively.ResultsOf 327 patients included in this study, 185 were contoured according to the anatomical protocol and 142 by the volumetric protocol. The two cohorts were well balanced, with the exception of significantly more patients in the anatomical cohort undergoing prophylactic feeding tube insertion (P < 0.001). With a minimum of 2 years of follow-up there was no significant difference in overall survival or recurrence between the two contouring protocols. Similarly, there was no significant difference in the rate of reported severe or all grades acute or late toxicity and no sustained significant difference in quality of life. However, there was a significant difference in favour of volumetric contouring in several domains of the MD Anderson Dysphagia Inventory questionnaire at 1 year, which persisted to 2 years in the dysphagia functional (P = 0.002), dysphagia physical (P = 0.009) and dysphagia overall function (P = 0.008) domains.ConclusionIn the context of the unplanned post-hoc analysis of a randomised trial, measurable improvement in long-term dysphagia has been shown following a reduction in the CTV. Further reductions in the CTV should be subject to similar scrutiny within the confines of a prospective study.     

Evaluation of the limitations of using the University of Washington Quality of Life swallowing domain alone to screen patients in the routine clinical setting

A broad patient-completed screening tool in routine clinical practice in head and neck oncology has merit, but clinicians should be aware that its simplicity could lead to some patients and the detail of their problems being missed. The purpose of this study was to compare the University of Washington Quality of Life (UWQoL) swallowing domain with the MD Anderson Dysphagia Inventory (MDADI) in relation to the need for interventions for swallowing around one year after treatment. The group comprised 112 consecutively referred patients to speech and language therapy between January 2007 and August 2009 after primary operation for previously untreated oral and oropharyngeal squamous cell carcinoma (SCC). A total of 78 patients completed questionnaires (median time of assessment 11.7 months, IQR 6.1–12.2). There were significant (p < 0.001) and moderately strong correlations (r_s = 0.51–0.62) between the UWQoL swallowing domain score and MDADI subscales and total scores, and also with individual MDADI questions: taking a great deal of effort (r_s = 0.71); being upset (r_s = 0.61); and not going out (r_s = 0.62) were the strongest in regard to swallowing. Use of a gastrostomy tube was associated with worse UWQoL and MDADI scores. In conclusion, patients who score 100 on the UWQoL do not require swallowing to be evaluated further. Those who score 70 could benefit from the detailed MDADI to help to clarify the specific problem and the impact it has before being referred to speech and language therapy. Those who score less than 70 should be brought to the attention of speech and language therapists to confirm that appropriate support and intervention are in place.     

声门上喉癌舌瓣修补术后吞咽功能恢复

目的 探讨声门上型喉癌舌瓣修复术后患者吞咽功能恢复情况。 方法 选取原发部位为会厌的声门上喉癌且行水平半喉切除术后再使用舌瓣修复声门上结构的患者23例。运用中文版安德森吞咽困难量表,评估术前及术后吞咽功能,就患者情绪维度、社会功能维度、生理功能维度进行全面评估。 结果 23例患者随访期间因肿瘤转移死亡2例、失访1例,完全恢复普通饮食20例,洼田饮水试验正常20例,术前总体吞咽得分中位数90.00［80.00,100.00］,术后得分中位数80.00［80.00,80.00］(P=0.359);情绪维度术前得分中位数91.67［77.50,93.33］,术后得分中位数80.00［80.00,83.33］(P=0.065);社会功能术前得分中位数90.00［80.00,96.00］,术后中位数84.00［80.00,92.00］(P=0.587);生理功能术前得分中位数83.75［76.25,89.38］,术后得分中位数80.00［75.00,84.38］(P=0.018)。 结论 声门上喉癌舌根未受累的患者,利用舌瓣修补声门上结构,术后均能恢复正常饮食习惯,在总体吞咽功能评分、情绪维度、社会功能维度均能获得较高的评分,在这三个方面术前及术后对比差异无统计学意义。舌瓣修补能较好地改善相关患者术后吞咽功能,提升患者术后生活质量。     

Correlation between dose to the pharyngeal constrictors and patient quality of life and late dysphagia following chemo-IMRT for head and neck cancer

Purpose

Aim of this study was to correlate dose to pharyngeal constrictors (PC) with subjective and observer-based assessments of swallowing in patients with head and neck cancer undergoing concomitant chemo-IMRT.

Materials and methods

Dose-volume histograms (DVHs) for superior constrictor (SC), middle constrictor (MC) and inferior constrictor (IC) were generated for 37 patients. Mean doses to SC, MC and IC were correlated to objective dysphagia grade (1 year, RTOG scoring) and global, total physical (TP) and most relevant components of the physical section (P6, P8) of the MD Anderson dysphagia inventory (MDADI) which was evaluated post-treatment. Odds ratios of dysphagia (>grade 0), poor global (<3), TP (<32), P6 (<3) and P8 (<3) for patients with mean dose > 60 Gy to SC and IC were calculated.

Results

There was no significant correlation between mean dose to PC and any of the analysed MDADI parameters and observer-assessed dysphagia grade. Odds ratio of dysphagia (>grade 0), poor global (<3), TP (<32), P6 (<3) and P8 (<3) for patients with mean dose > 60 Gy to IC and SC were not significantly higher than those for patients receiving <60 Gy.

Conclusion

This study did not find a statistically significant correlation between radiation dose to the PC and observer-assessed dysphagia grade or patient-reported MDADI questionnaire at 1 year.