A recent study in Shanghai, China, associated high intakes of salt-preserved fish and meat with an increased risk of oral and pharyngeal cancer. N-nitroso compounds in the salted foods may play a role in carcinogenesis. The relationship of salted meat consumption to oropharyngeal cancer risk has also been studied in Uruguay, another country where salt-preserved foods are traditional components of the diet.

The hospital-based case-control study was conducted in the Oncology Institute in Montevideo. The researchers interviewed 246 men with oral or pharyngeal cancer and 253 male controls hospitalized for other diseases. The food frequency questionnaire used in this study was limited; it did, however, include specific questions about past and current consumption of fresh, salted, and barbecued meats.

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—      As is true in most studies of oral and pharyngeal cancer, tobacco smoking and alcohol drinking were the most important risk factors. After controlling for these factors and for age, place of residence, and education, the researchers found that current salted meat consumption was associated with a significant two-fold increase in oropharyngeal cancer risk. The risk was greater for those who consumed salted meat more frequently. Past consumption of salted meat was associated with a 40% increase in risk, which did not achieve statistical significance.

The results of this study indicate that consumption of salt-preserved foods is associated with increased oropharyngeal cancer risk in this South American country, just as it is in Shanghai.

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S. M. Zeitels, C. W. Vaughan and S. Ruh Otolaryngology Section, Veterans Affairs Medical Center, Boston, MA.

Suprahyoid pharyngotomy has been utilized as the standard approach to tongue base cancer not involving the larynx or mandible for the last 6 years at the Department of Veterans Affairs Medical Center, Boston, Mass. Review of 15 patients revealed that all had advanced disease (stage III and stage IV); 14 cases involved the tongue base, and one was on the posterior pharyngeal wall. By following the hyoepiglottic ligament, precise entry into the vallecula was routine. No injuries of vital neurovascular structures or compromised tumor margins were present; one tracheotomy was performed. Primary closure without the use of flaps was accomplished in 14 of 15 patients. No locoregional recurrences were found, with a median follow-up of 25 months. However, two patients died of another unrelated cancer, and two patients died of a myocardial infarction unrelated to their surgery. Suprahyoid pharyngotomy is a familiar approach often utilized during laryngectomy. In our experience, it provides excellent exposure of the oropharynx, can be combined with a transoral approach to avoid mandibulotomy without precluding this option, allows for simple reconstruction, and has a low complication rate.

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F. A. Pugliano, J. F. Piccirillo, M. R. Zequeira, B. Emami, C. A. Perez, J. R. Simpson and J. M. Fredrickson
Department of Otolaryngology, Washington University School of Medicine, St Louis, Mo, USA.

OBJECTIVE: To improve the classification and survival estimates for patients with oropharyngeal cancer by combining cancer symptom severity and comorbidity with the current TNM cancer staging system. DESIGN: Retrospective medical record review using explicit coding criteria. SETTING: University medical center. PATIENTS AND METHODS: Two hundred ninety-six patients receiving initial treatment from January 1, 1980, to December 31, 1989. Multivariate analysis identified patient factors that had a significant impact on 5-year survival. These patient factors, symptom severity and comorbidity, were combined with cancer stage to create a composite clinical-severity staging system. MAIN OUTCOME MEASURE: Five-year survival. RESULTS: The overall 5-year survival rate was 38% (111/ 296). Survival by TNM cancer stage was 67% (18/27) for stage I, 46% (24/52) for stage II, 31% (26/85) for stage III, and 32% (43/132) for stage IV (chi2=10.84; P=.001). When patients were grouped according to the clinical-severity staging system, survival rates were 70% (16 of 23) for stage A, 47% (71 of 152) for stage B, 27% (18 of 67) for stage C, and 11% (6 of 54) for stage D (chi2=34.49; P=.001). CONCLUSIONS: Survival estimates can be improved by adding carefully studied and suitably defined patient variables to the TNM cancer stage. The current TNM cancer staging system for oropharyngeal cancer is based solely on the morphologic description of the tumor and disregards the clinical condition of the patient. Cancer symptom severity and comorbidity have a significant impact on survival. Continued exclusion of patient factors leads to imprecision in prognostic estimates and hinders interpretation of clinical studies.

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William J. Blot¹, Joseph K. McLaughlin, Deborah M. Winn, Donald F. Austin, Raymond S. Greenberg, Susan Preston-Martin, Leslie Bernstein, Janet B. Schoenberg, Annette Stemhagen and Joseph F. Fraumeni, Jr.

National Cancer Institute, Bethesda, Maryland 20892 [W. J. B., J. K. M., J. F. F.]; National Center for Health Statistics, Hyattsville, Maryland 20782 [D. M. W.]; California State Department of Health Services, Emeryville, California 94608 [D. F. A.]; Emory University, Atlanta, Georgia 30322 [R. S. G.]; University of Southern California, Los Angeles, California 90033 [S. P-M., L. B.]; and New Jersey Department of Health, Trenton, New Jersey 08625 [J. B. S., A. S.]

A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.

¹ To whom requests for reprints should be addressed, at Division of Cancer Etiology, Epidemiology and Biostatistics Program, NIH, Bethesda, MD 20892.

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Jacqueline R. Starr², Janet R. Daling, E. Dawn Fitzgibbons, Margaret M. Madeleine, Rhoda Ashley, Denise A. Galloway and Stephen M. Schwartz

Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195 [J. R. S., J. R. D., M. M. M., S. M. S.]; Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 [J. R. D., E. D. F., M. M. M., S. M. S.]; Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, WA 98195 [R. A.]; Program in Cancer Biology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 [D. A. G.]; Department of Microbiology, School of Medicine, University of Washington, Seattle, WA 98195 [D. A. G.]

In vitro and animal models suggest that the herpes simplex virus 1 (HSV1) may contribute to the development of oropharyngeal squamous cell carcinoma (OSCC). To determine whether the risk of OSCC is related to infection with HSV1 in humans, we recruited 260 patients from 18 to 65 years old who were newly diagnosed with OSCC between 1990–1995 while residing in three western Washington State counties. For comparison, we recruited at random 445 controls frequency matched to cases on age and sex. Participants completed in-person interviews and provided serum samples that were tested for antibody response to HSV1. After adjusting for sex, cigarette smoking, alcohol consumption, age, and income, HSV1 antibody positivity was associated with a slightly increased risk of OSCC [adjusted odds ratio (OR), 1.3; 95% confidence interval (CI), 0.9–2.0]. The adjusted association between HSV1 antibody positivity and OSCC risk among those who were current cigarette smokers (OR, 4.2; CI, 2.4–7.1) was stronger than would be predicted based on the additive combination of smoking alone (OR, 2.3; CI, 1.2–4.2) and HSV1 seropositivity alone (OR, 1.0; CI, 0.6–1.7). There was suggestive evidence that the association between HSV1 infection and OSCC was similarly modified by evidence of HPV infection but no evidence of effect modification with alcohol consumption. This population-based study suggests that HSV1 may enhance the development of OSCC in individuals who are already at increased risk of the disease because of cigarette smoking or HPV infection.

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General Information

Oropharyngeal cancer is uncommon; in the United States, an estimated 8,300 new cases of pharyngeal cancer, including cancers of the oropharynx and hypopharynx, are diagnosed each year, with an estimated mortality of 2,000 deaths.[1] Worldwide, cancers of the oropharynx and hypopharynx account for an estimated 123,000 new cases per year, with an estimated mortality of 79,000 deaths.[2] Typically, oropharyngeal cancer involves patients in the fifth through seventh decades of life; men are afflicted 3 to 5 times more than women.[1,2,3]

Similar to other cancers of the head and neck, tobacco and alcohol abuse represent the most significant risk factors for the development of oropharyngeal cancer.[3,4] (Refer to the PDQ summaries on Hypopharyngeal Cancer and Lip and Oral Cavity Cancer for more information.) Other risk factors may include:[5]

—      A diet poor in fruits and vegetables.[6]

—      The consumption of maté, a stimulant beverage commonly consumed in South America.[7]

—      The chewing of betel quid, a stimulant preparation commonly used in parts of Asia.[8]

—      Infection with the human papillomavirus (HPV), especially HPV-type-16, also known as HPV-16.[9,10]

Defective elimination of acetaldehyde, a carcinogen generated by alcohol metabolism, poses an additional risk factor for oropharyngeal cancers. In individuals, primarily East Asians, carrying an inactive mutant allele of alcohol dehydrogenase-2, alcohol consumption is associated with a susceptibility to multiple metachronous oropharyngeal cancers that are caused by the decreased elimination of acetaldehyde.[11]

Anatomically, the oropharynx is located between the soft palate superiorly and the hyoid bone inferiorly; it is continuous with the oral cavity anteriorly and communicates with the nasopharynx superiorly and the supraglottic larynx and hypopharynx inferiorly. The oropharynx is divided into the following sites:[12]

—      Base of the tongue, which includes the pharyngoepiglottic folds and the glossoepiglottic folds.

—      Tonsillar region, which includes the fossa and the anterior and posterior pillars.

—      Soft palate, which includes the uvula.

—      Pharyngeal walls, that is, posterior and lateral.

The regional lymph node anatomy of the head and neck contains lymph nodes that run parallel to the jugular veins, spinal accessory nerve, and facial artery and into the submandibular triangle; an understanding of this anatomy and the status of regional lymph nodes is critical to the care of head and neck cancer patients.[3,13] The regions of the neck have been characterized by levels (I-V) to facilitate communication regarding the lymph node anatomy:

—      Level I contains the submental and submandibular lymph nodes.

—      Level II contains the upper jugular lymph nodes, which are above the digastric muscle.

—      Level III contains the mid-jugular lymph nodes, which are between the omohyoid muscle and the digastric muscle.

—      Level IV contains the lower jugular lymph nodes.

—      Level V contains the lymph nodes of the posterior triangle.

Histologically, almost all oropharyngeal cancers are squamous cell carcinomas (SCCs).[3] Other cancers in this area include minor salivary gland carcinomas, lymphomas, and lymphoepitheliomas, also known as tonsillar fossa. (Refer to the PDQ summaries on Salivary Gland Cancer, Adult Hodgkin’s Lymphoma, and Adult Non-Hodgkin’s Lymphoma for more information.)

The concept of field cancerization may be responsible in part for the multiple, synchronous primary SCCs that occur in oropharyngeal cancer. This concept, originally described in 1953, proposes that tumors develop in a multifocal fashion within a field of tissue chronically exposed to carcinogens.[14] Molecular studies detecting genetic alterations in histologically normal tissue from high-risk individuals have provided strong support for the field cancerization concept.[15,16,17,18,19]

Clinically, cancers of the base of the tongue are insidious. These cancers can grow in either an infiltrative or exophytic pattern. Because the base of the tongue is devoid of pain fibers, these tumors are often asymptomatic until they have progressed significantly.[12] Symptoms may include pain, dysphagia, weight loss, referred otalgia secondary to cranial nerve involvement, trismus secondary to pterygoid muscle involvement, fixation of the tongue that is caused by infiltration of the deep muscle, and a mass in the neck.[3,12] Lymph node metastasis is common because of the rich lymphatic drainage of the base of the tongue. Approximately =70% of patients have ipsilateral cervical nodal metastases; =30% of patients have bilateral cervical lymph node metastases.[12,20] Cervical lymph nodes involved commonly include levels II and III.

The symptoms of tonsillar lesions include pain, dysphagia, weight loss, ipsilateral referred otalgia, and a mass in the neck.[3,12] The anterior tonsillar pillar and tonsil is the most common location for a primary tumor of the oropharynx.[12] Lesions involving the anterior tonsillar pillar may appear as areas of dysplasia, inflammation, or a superficial spreading lesion. These cancers can progress over a broad region including the lateral soft palate, retromolar trigone and buccal mucosa, and tonsillar fossa.[3,12] The lymphatic drainage is primarily to level II nodes.

Lesions of the tonsillar fossa may be either exophytic or ulcerative and have a pattern of extension similar to those of the anterior tonsillar pillar. These tumors present in advanced-stage disease more often than cancers of the tonsillar pillar. Approximately 75% of patients will present with stage III or stage IV disease.[3,12] The lymphatic drainage is primarily to level V nodes. Tumors of the posterior tonsillar pillar can extend inferiorly to involve the pharyngoepiglottic fold and the posterior aspect of the thyroid cartilage. These lesions more frequently involve level V nodes.

Soft palate tumors are primarily found on the anterior surface.[12] Lesions in this area may remain superficial and in early stages.[3] The lymphatic drainage is primarily to level II nodes.

Tumors of the pharyngeal wall are typically diagnosed in an advanced stage, which is due to the silent location in which they develop.[3,12] Symptoms may include pain, bleeding, weight loss, and a neck mass. These lesions can spread superiorly to involve the nasopharynx, posteriorly to infiltrate the prevertebral fascia, and inferiorly to involve the pyriform sinuses and hypopharyngeal walls. Primary lymphatic drainage is to the retropharyngeal nodes and level II and III nodes. Because most pharyngeal tumors extend past the midline, bilateral cervical metastases are common.

Precancerous lesions of the oropharynx include leukoplakia, erythroplakia, and mixed erythroleukoplakia.[5] These are clinical terms that have no specific histopathologic connotations.[21] Leukoplakia, the most common of the 3 conditions, is defined by the World Health Organization as “a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.”[22] The diagnosis of leukoplakia is one of exclusion; conditions such as candidiasis, lichen planus, leukoedema, and others must be ruled out before a diagnosis of leukoplakia can be made.[5]

The prevalence of leukoplakia in the United States is decreasing; this decline has been related to a reduction of tobacco consumption.[23] Although erythroplakia is not as common as leukoplakia, it is much more likely to be associated with dysplasia or carcinoma.[5,24]

The clinical anatomic staging of oropharyngeal cancers involves both clinical assessment and imaging techniques.[3,13] Diagnostic methods under development involve the molecular analysis of tissue from the margins of lip and oral cavity SCCs (i.e., molecular staging) to detect tumor-associated genetic alterations in cells that appear normal by conventional light microscopy. Molecular staging may predict the likelihood of recurrence and may help to establish the relationship between index lesions of SCCs and subsequent lesions.[25,26]

Traditionally, surgery and/or radiation therapy have been the standards for treatment of oropharyngeal cancers; these treatment modalities are frequently complicated by suboptimal control of locoregional disease and significant long-term functional deficits.[3,27] Although specific indications for primary surgical resection exist, some investigators suggest that the concurrent use of multiagent chemotherapy and radiation has become the standard of care for the management of patients with late-stage disease, and surgery is often reserved for salvage of those patients who fail definitive nonoperative treatment.[25,27,28] Studies using aggressive and uncompromised radiation therapy with concurrent multiagent chemotherapy have consistently demonstrated a survival and locoregional control benefit.[29,30,31,32,33] This treatment approach emphasizes organ preservation and functionality. New treatments under development include various biologic therapies (i.e., vaccines, growth factor-receptor antagonists, cyclin-dependent kinase inhibitors, oncolytic viruses, and others) and photodynamic therapy.[25,34,35,36,37,38,39,40,41]

The rate of curability of cancers of the oropharynx varies depending on the stage and specific site. Local control rates for early base of tongue cancers approximate 85%.[3] In a large retrospective study involving 262 patients with base of tongue cancer, the overall 5-year disease-specific survival for patients with all stages of disease was approximately 50%. Treatment modalities included surgery with and without radiation therapy and radiation therapy alone. None of the treatment modalities had a significant survival advantage either overall or within the stages.[42]

In a retrospective study involving 162 patients with tonsil carcinoma, 84 patients were treated with primary surgery, which was followed by radiation therapy and/or chemotherapy if histologic signs of aggressive behavior were identified. Survival rates were 89% for stage I, 91% for stage II, 79% for stage III, and 52% for stage IV.[43] In a retrospective study of 188 patients with SCC of the soft palate, uvula, and anterior tonsillar pillar, treatment to the primary site consisted of radiation therapy for 150 patients, surgery for 28 patients, and combined therapy for 10 patients. The overall determinant survival was 80% at 2 years, but it fell to 67% at 5 years.[44] In another retrospective study, 148 patients received definitive radiation therapy for SCC of the pharyngeal wall. Cause-specific survival rates were 89% for stage I, 88% for stage II, 44% for stage III, and 34% for stage IV. Twice-daily fractionation, stage I to stage II disease, and an oropharyngeal primary site were associated with improved locoregional control.[45]

HPV-positive oropharyngeal cancers may represent a distinct disease entity that is causally associated with HPV infection and that is also associated with an improved prognosis. Several studies indicate that individuals with HPV-positive tumors have significantly improved survivals.[10,46,47] In a prospective study involving 253 patients with newly diagnosed or recurrent head and neck SCC, HPV was detected in 25% of the cases. Poor tumor grade and an oropharyngeal site independently increased the probability of HPV presence.[10]

The risk of developing a second primary tumor in patients with tumors of the upper aerodigestive tract has been estimated to be 3% to 7% per year.[48,49] Because of this risk, surveillance of these patients should be lifelong. Patients should be counseled that continued smoking and alcohol consumption after treatment has been associated with the development of second primary tumors of the aerodigestive tract.[50,51,52]

To date, SCC of the oropharynx has not been associated with any specific chromosomal or genetic abnormalities. Genetic/chromosomal aberrations in these cancers are complex.[53,54] Despite the lack of specific genetic abnormalities, testing for genetic alterations or ploidy in early oropharyngeal lesions may identify patients who are at the greatest risk for progression and may lead to more definitive therapy.[25]

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DG Pfister, LB Harrison, EW Strong, JP Shah, RW Spiro, DH Kraus, JG Armstrong, MJ Zelefsky, DE Fass and MH Weiss

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

PURPOSE: To evaluate the feasibility and efficacy of a strategy using induction chemotherapy followed by radiation therapy (RT) as a means of organ-function preservation in patients with advanced oropharynx cancer. PATIENTS AND METHODS: From January 1983 to December 1990, 33 patients with advanced squamous cell oropharynx cancer whose appropriate surgical management would have required a tongue procedure and potential total laryngectomy were treated with one to three cycles of cisplatin (CDDP)-based induction chemotherapy. Patients with a complete response (CR) or partial response (PR) at the primary site then received definitive external-beam RT with or without interstitial implant with or without neck dissection with surgery to the primary tumor site reserved for disease persistence or relapse; patients with less than a PR after chemotherapy had appropriate surgery and postoperative RT recommended. RESULTS: With a median follow-up period of 6.2 years, actuarial overall and failure-free survival rates at 5 years are 41% and 42%, respectively. Chemotherapy toxicity contributed to the death of two patients and was possibly a factor in two others. Local control was achieved in 14 patients (42%) without any surgery to the larynx or tongue. Among 13 patients currently alive, all had a preserved larynx and only one required tongue surgery; 12 of 13 have speech subjectively described as always understandable; and nine of 13 have no significant restrictions in their diet. CONCLUSION: This treatment program is feasible and effective in patients with advanced oropharynx cancer and produces an excellent functional outcome in most long-term survivors. Modifications to optimize patient selection, minimize toxicity, and improve local control are indicated. The relative toxicity, efficacy, and functional outcome provided by this and other chemotherapy and RT programs versus either standard surgery and/or RT options can only be addressed in a randomized comparison of these therapies.

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A study of 100 women diagnosed with cancers at the back of the throat, published in the New England Journal of Medicine, has linked human papillomavirus (HPV) with throat cancer. It concluded oral HPV infection was associated with oropharyngeal cancer among people with or without the other risk factors of tobacco and alcohol use.

Infection with sexually transmitted HPV is a cause of virtually all cervical cancers.

The researchers from Johns Hopkins University also found a high lifetime number of oral sex or vaginal sex partners, engagement in casual sex, early age at first sexual encounter and infrequent use of condoms were associated with a strain of HPV-positive oropharyngeal cancer. They conclude that the “widespread oral sexual practices among adolescents” may have contributed to a rise of this type of cancer in the US, and provide a rationale for HPV vaccination in both boys and girls.

Cancer Council Australia chief executive Ian Olver said there was a known association between throat cancer and HPV. But he said it remained rare and there was no evidence of it rising.

“Everyone that gets infected by HPV won’t go on to get throat cancer,” he said. The findings did not mean people should change their behaviour. “It would be like saying stop having sex or you’ll get cancer of the cervix. That doesn’t apply.”

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Imaging studies have an important role in defining the extent of oropharyngeal neoplasms and coming to an accurate staging of these lesions. Besides influencing treatment choice, imaging studies can also be used to monitor tumour response to treatment, and as an adjunct to clinical follow-up in order to detect treatment failure as early as possible.

Keywords: Squamous cell cancer, head and neck, pharynx

Head and neck cancer commonly originates from the oropharynx. As in most head and neck sites, squamous cell cancer is the most frequently encountered malignant disease. Cigarette smoking and excessive alcohol consumption are well-known risk factors. The accuracy of pre-therapeutic staging is an important factor in the treatment planning of oropharyngeal neoplasms. High-quality imaging is of considerable help to the clinician examining patients with oropharyngeal cancer, by revealing submucosal tumour spread and detecting subclinical adenopathies.

Tongue base cancer

Cancer in the tongue base tends to grow silently and deeply, and is often larger than suspected at clinical examination. Tumours may spread, along the palatoglossal muscle, cornering the glossotonsillar sulcus, to involve the anterior tonsillar pillar.

Anterior spread into the floor of the mouth and/or tongue body may occur, along the mylo- and/or hyoglossal muscle, and/or along the lingual neurovascular bundle (Fig. 2). Tongue base cancer may also grow in a retrograde fashion along the lingual vessels towards the external carotid artery [1]. Vascular and perineural tumour spread is associated with reduced local and regional tumour control and reduced patient survival. A tumour mass with a overall diameter of more than 2 cm on imaging predicts vascular and perineural tumour spread [2]. Infiltration of the normal fatty tissue planes in the base of the tongue, of the fat in the sublingual space, as well as irregular tumour margins are also associated with an increased risk of vascular and perineural tumour spread. Such findings are related to overall tumour bulk.

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1.        Voice, Speech and Language Service and Swallowing Center Northwestern University Medical School Chicago, IL Veterans Administration Lakeside Medical Center, Chicago, IL

2.        Northwestern University Evanston, IL

3.        The Robert H. Lurie Comprehensive Cancer Center Biostatistics Section Northwestern University Medical School Chicago, IL

4.        Section of Radiation Oncology Northwestern University Chicago, IL

This study examined tongue function and its relation to swallowing in 13 subjects with oral or oropharyngeal cancer treated with primary radiotherapy ± chemotherapy and 13 age- and sex-matched control subjects. Measures of swallowing and tongue function were obtained using videofluoroscopy, pretreatment and 2 months posttreatment. Maximum isometric strength and endurance at 50% of maximum strength were obtained with the Iowa Oral Performance Instrument (IOPI). Control subjects were tested once. All subjects with head and neck cancer were evaluated pretreatment and 2 months posttreatment. No significant differences were found for the tongue function measures pre- and 2 months posttreatment in the group with head and neck cancer. Significantly higher tongue strength was observed in the control than in the group with head and neck cancer both pre- and posttreatment. No significant differences were found for the 2 groups for tongue endurance measures. Significant correlations of tongue strength and endurance and some swallow measures were found pre- and posttreatment for the group with head and neck cancer and for the control group. These correlations included oral and pharyngeal temporal swallow measures and oropharyngeal swallow efficiency. Pretreatment differences between the 2 groups in tongue strength were likely related to tumor bulk, pain, and soreness. Two-month posttreatment differences were likely related to radiation ± chemotherapy changes to the oral and pharyngeal mucosa. This study provides support for the hypothesis that tongue strength plays a role in oropharyngeal swallowing, particularly related to the oral phase of the swallow.

KEY WORDS: swallowing, radiotherapy, tongue strength, cancer, videofluorography

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