Baş-boyun bölgesine radyoterapi uygulanan hastaların yutma güçlüğü, ağız kuruluğu ve beslenme durumunda oluşan değişiklikler açısından değerlendirilmesi

Abstract

Amaç: Bu çalışmada, baş-boyun bölgesine radyoterapi uygulanan hastaların ağız içi muayenesinin yapılması ve sık görülen yan etkilerden olan ağız kuruluğu, yutma güçlüğü ve beslenme durumunda oluşan değişikliklerin değerlendirilmesi amaçlanmaktadır. Yöntem: Çalışmaya primer baş boyun kanseri nedeniyle radyoterapi veya kemoradyoterapi uygulaması yapılan, cerrahi tedavi uygulanmamış 18-80 yaş arası 26 hasta dahil edilmiştir. Bulgular: Tedavi başlangıcında çalışmaya dahil edilen hastaların tamamında (%100) yutkunmada güçlük ve ağız kuruluğu tespit edildi, 21 tane hastada (%80.2) beslenme problemi bulunmaktaydı. Sonuç: Değişen ve gelişen tedavi seçenekleri ve organ koruyucu yaklaşımla sağ kalımın artması, koruyucu önlemlerin alınmasının, tedavi sonrası oluşan yan etkilerin ortadan kaldırılmasının ve gerek tıp gerekse diş hekimliği için bu konuda farkındalığın geliştirilmesinin önemini daha da arttırmaktadır. Her ne kadar radyoterapi teknikleri ve teknolojisi gelişim kaydetse de çalışmamız tedavi sonrası ağız kuruluğu, yutma güçlüğü ve beslenme bozukluğu gibi morbiditelerin hastalarda halen önemli bir sorun olduğunu ortaya koymuştur.

Keywords

• Ağız kuruluğu
• baş-boyun kanseri
• radyoterapi
• yutma güçlüğü

Evaluation of the changes in swallowing disorder, dry mouth and nutritional status of patients receiving radiotherapy to the head and neck region

Abstract

Aim: The aim in this study is to perform an oral examination of the patients who have received radiotherapy, mainly of the head and neck region, also, to evaluate the common side effects of radiotherapy (i.e: dysphagia, dry mouth and nutritional problems). Methods: The study included 26 patients ages 18-80 who underwent radiotherapy or chemo radiotherapy for primary head and neck cancer without surgical treatment. Results: At the beginning of treatment all patients(100%) had disphagia and dry mouth, 21 patients (80.2%) had nutritional problems. Conclusion: Due to the changing and improving treatment alternatives and organ-sparing modality, the increase in the survival rate raises the significance of taking protective precautions, eliminating the post-treatment side effects and raising awareness on this issue in terms of both medicine and dentistry. Although radiotherapy and technology have improved, our study has revealed that post-treatment morbidities as dry mouth, dysphagia and nutrition problems are still significant problems for the patients.

Keywords

• Dry mouth
• dysphagia
• head and neck cancer
• radiotherapy

References

1. 1. Çıtlak K, Kapucu S. Kemoterapi ve radyoterapi uygulanan baş-boyun kanserli hastalarda mukozit yönetimine yönelik kullanılan oral ajanların retrospektif olarak incelenmesi. Journal of Hacettepe University Faculty of Nursing. 2017, 4(1), 15-27.
2. 2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A cancer journal for clinicians. 2018;68(6):394-424.
3. 3. Sanderson R, Ironside J. Squamous cell carcinomas of the head and neck. BMJ. 2002;325(7368):822-827.
4. 4. Kent ML, Michael T. Brennan, Jenene L. Noll, Philip C. Fox, Stuart H. Burri, Jane C. Hunter, Peter B. Lockhart. Radiation-induced trismus in head and neck cancer patients. Supportive care in cancer. 2008;16(3):305-309.
5. 5. Freitas DA, Caballero AD, Pereira MM, Oliveira SKM, Silva GPE, Hernández CIV. Oral sequelae of head and neck radiotherapy. Revista CEFAC. 2011;13(6):1103-1108.
6. 6. Kraaijenga SA, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJ, van den Brekel MW. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. European Archives of Oto-Rhino-Laryngology. 2015;272(11):3521-3531.
7. 7. Likhterov I, Ru M, Ganz C, Urken M, Chai R, Okay D, Liu J, Stewart R, Culliney B, Palacios D, Lazarus C. Objective and subjective hyposalivation after treatment for head and neck cancer: Long‐term outcomes. The Laryngoscope. 2018;128(12):2732-2739.
8. 8. Kuhnt T, Jirsak N, Müller AC, Pelz T, Gernhardt C, Schaller HG, Janich M, Gerlach R, Dunst J. Quantitative and qualitative investigations of salivary gland function in dependence on irradiation dose and volume for reduction of xerostomia in patients with head-and-neck cancer. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft 2005;181(8):520-528.

9. 9. Marmiroli L, Salvi G, Caiazza A, Di Rienzo L, Massaccesi M, Murino P, Macchia G. Dose and volume impact on radiation-induced xerostomia. Rays. 2005;30(2):145-148.
10. 10. Franzén L, Funegård U, Ericson T, Henriksson R. Parotid gland function during and following radiotherapy of malignancies in the head and neck: A consecutive study of salivary flow and patient discomfort. European Journal of Cancer. 1992;28(2-3):457-462.
11. 11. Li H, Li L, Huang X, Li Y, Zou T, Zhuo X, Chen Y, Liu Y, Tang Y. Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma. Strahlentherapie und Onkologie. 2019; 195(6):457-467.
12. 12. Kufeldt J, Viehrig M, Schweikert D, Fritsche A, Bamberg M, Adolph M. Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department. Strahlentherapie und Onkologie. 2018;194(11):1049-1059.
13. 13. Small W, Woloschak GE. Management of Radiation-Induced Head and Neck Injury. Radiation toxicity: a practical medical guide. 1. Baskı, New York, Springer Science & Business Media, 2006: 23-42.
14. 14. Van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Rasch CR, Hilgers FJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: Feasibility, compliance, and short-term effects. Dysphagia. 2011;26(2):155-170.
15. 15. Rosenthal D, Mendoza T, Cleeland C. Identifying head and neck cancer patients at risk for high symptom burden during treatment. Journal of Clinical Oncology. 2009;27(15_suppl):6066-6066.
16. 16. Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge B, Suntharalingam M. Prevalence and correlates of symptoms and uncertainty in illness among head and neck cancer patients receiving definitive radiation with or without chemotherapy. Supportive Care in Cancer. 2012;20(8):1885-1893.
17. 17. Kırca K, Kutlutürkan S. Control of early and late stage symptoms related to radiotherapy in head and neck cancers. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2018;9(2):110-117 .
18. 18. Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. The lancet oncology. 2006;7(2):175-183. 19. Ahadian H, Yassaei S, Bouzarjomehri F, Targhi MG, Kheirollahi K. Oral complications of the oromaxillofacial area radiotherapy. Asian Pacific journal of cancer prevention: APJCP. 2017;18(3):721.
19. 20. Greenberg M, Glick M. Burket's Oral Medicine, Diagnosis & Treatment. 10. Baskı, Hamilton, BC Decker. 2003: 194-234.
20. 21. Mira JG, Wescott WB, Starcke EN, Shannon IL. Some factors influencing salivary function when treating with radiotherapy. International Journal of Radiation Oncology* Biology* Physics. 1981;7(4):535-541.
21. 22. Karadayı B, Akmansu M, Dirier A, Akdemir Ö. Amifostinin sitoprotektif etkinliğinin kantitatif tükürük bezi sintigrafisi ile değerlendirilmesi. Dicle Tıp Dergisi. 2005;32(4):183-189.
22. 23. Roesink JM, Moerland MA, Battermann JJ, Hordijk GJ, Terhaard CH. Quantitative dose-volume response analysis of changes in parotid gland function after radiotheraphy in the head-and-neck region. International Journal of Radiation Oncology* Biology* Physics. 2001;51(4):938-946.
23. 24. Levendag PC, Teguh DAN, Voet P, van der Est H, Noever I, de Kruijf W, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmıtz PIM, Heijmen BJ. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: A dose-effect relationship. Radiotherapy and Oncology. 2007;85(1):64-73.
24. 25. Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. International Journal of Radiation Oncology* Biology* Physics. 2001;50(3):695-704.
25. 26. Jensen K, Lambertsen K, Grau C. Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiotherapy and Oncology. 2007;85(1):74-82.
26. 27. Akın MM. Nazofarenks kanserlerinde farklı radyoterapi tekniklerinde normal doku dozlarının yaşam kalitesine etkisi (Uzmanlık Tezi). Fadime Akman. Yayınlanmamış Tezi. İzmir. 2013.
27. 28. Yanni A, Dequanter D, Lechien J, Loeb I, Rodriguez A, Javadian R, Van Gossum M. Malnutrition in head and neck cancer patients: Impacts and indications of a prophylactic percutaneous endoscopic gastrostomy. European annals of otorhinolaryngology, head and neck diseases. 2019;6:27-33.
28. 29. Kraaijenga S, Oskam I, van der Molen L, Hamming-Vrieze O, Hilgers F, Van Den Brekel M. Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer. Oral oncology. 2015;51(8):787-794.
29. 30. Volpe S, Marvaso G, Alterio D, Ciardo D, Sabbatini A, Zagallo E, Valoriani F, Fanetti G, Ferrari A, Rocca MC, Ansarin M, Jereczek-Fossa BA. Nutritional Intervention for Nonsurgical Head and Neck Cancer Patients Treated with Radiation Therapy: Results from a Prospective Stepped-Wedge Clinical Protocol. Nutrition and cancer. 2018:1-9.
30. 31. Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, Flentie M, Eckel HE, Mueller RP. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy—results of a multicentric randomized German trial in advanced head-and-neck cancer. International Journal of Radiation Oncology* Biology* Physics. 2001;50(5):1161-1171.
31. 32. Akman F. Yerel ileri baş-boyun kanserlerinde kemoradyoterapi. Turkiye Klinikleri Medical Oncology-Special Topics. 2010;3(1):36-40.
32. 33. Akkaş EA, Yücel B, Kılıçkap S, Babacan NA, Altuntaş E. Baş boyun kanserli hastalarda tedavi sonuçları ve prognostik faktörler. Cumhuriyet Medical Journal. 2013;35(1):66-75.
33. 34. Moroney LB, Helios J, Ward EC, Crombie J, Burns CL, Yeo SQ, Pelecanos A, Spurgin AL, Blake C, Kenny L, Chua B, Hughes BGM. Radiotherapy for cutaneous head and neck cancer and parotid tumours: a prospective investigation of treatment-related acute swallowing and toxicity patterns. Supportive Care in Cancer. 2019;27(2):573-581.