Table 2.
Summary of articles investigating the prevention and treatment of dysphagia post NPC.
| Author | Sample size (gender) | Age (years, Mean ± SD) | Tumour staging of participants | Treatment techniques (n) | Main objectives | Outcome measures | Main findings | MMAT quality rating |
|---|---|---|---|---|---|---|---|---|
| Prevention of dysphagia | ||||||||
| Cetin et al33 | 20 (5F:15M) | 3D conformal – 43.1; IMRT – 43.8 | Stage Ⅰ – 1; Stage Ⅱ – 7; Stage Ⅲ – 12 |
3D Conformal RT (10); IMRT (10) | Compare the effects of 3D conformal RT with IMRT on swallowing function | FEES and Self-rating of symptoms | No difference between 3D conformal RT and IMRT in the swallowing outcome | 3/5 |
| Fua et al34 | 28 (7F:21M) | 50.0 | Stage Ⅰ – 1; Stage Ⅱ – 5; Stage Ⅲ – 14; Stage Ⅳ – 8 |
Whole-field IMRT (20); IMRT with central shielding (8); Induction chemotherapy (21); Concurrent chemotherapy (23) | Quantify the dose delivered to the pharyngo–esophageal axis usingIMRT techniques and correlate with swallowing toxicity | Clinical assessment; feeding tube placement duration | Central shielding was effective in reducing acute RT toxicity of dysphagia | 4/5 |
| Jiang et al36 | 134 (33F:101M) | 44 | T1-T2 – 37, T3-T4 – 97; N0–N1 – 59, N2–N3 – 75 |
IMRT (134); Neoadjuvant chemotherapy (48); Concurrent chemotherapy (108) | Investigate the dose-volume effect on the swallowing function | Dose-volume histogram and RTOG/EORTC scale score and MDADI | Significant relationship between dysphagia and radiation doses to the superior and inferior constrictor muscles | 4/5 |
| Messer et al35 | 72 (15F:57M) | 52 ± 12 | T1-T2 – 29, T3-T4 – 39; N0–N1 – 28, N2–N3 – 39 |
IMRT (72); Induction chemotherapy (49); Concurrent chemotherapy (63) | Characterize the changes in the MRI signal intensity in dysphagia-associated structures as a function of RT | Signal intensity of MRI | Dose dependent decrease in the late T1 signal intensity is associated with higher RT doses to the superior pharyngeal constrictor muscle | 5/5 |
| Treatment of dysphagia | ||||||||
| Fong et al32 | 13 (2F:11M) | 42.0 | T1 – 1, T2-T3 – 10; N0–N1 – 8, N2 – 3 |
RT (9); C/RT (4) | Determine the use of balloon dilation for treating cricopharyngeal dysfunction | VFSS and MDADI | Balloon dilation was effective in treating dysphagia, reduce aspiration risk and improve quality of life | 4/5 |
| Lei et al31 | 9 (9M) | 62.5 | Not available | RT only (9) | Study the effect of modified laryngotracheal separation on patients with intractable aspiration pneumonia | Incidence of pneumonia, weight, nutritional status | Modified laryngotracheal separation is effective in eliminating intractable aspiration pneumonia. Careful patient selection is required | 3/5 |
| Lin et al15 | 20 (8F:12M) | Electrical stim group – 52.3; Exercise group – 56.1 | Stage Ⅱ – 3; Stage Ⅲ – 10; Stage Ⅳ – 6 |
Single RT (17); 2 courses of RT (3) | Assess the effectiveness of functional electrical stimulation on NPC patients | VFSS and QoL measures | Functional electrical stimulation was effective in improving swallowing function and its related quality of life | 4/5 |
| Long & Wu28 | 60 (31F:29M) | Treatment group – 56.5; Control group – 55.83 | Not available | RT (60) | Evaluate the therapeutic effect of (NMES and balloon dilation in NPC patients | Clinical assessment, VFSS | Combined NMES and balloon dilatation treatment were effective for improving swallowing function | 3/5 |
| Tang et al29 | 43 (11F:32M) | 49.3 ± 11.0 | Not available | RT only (43) | Evaluate the therapeutic effect of rehabilitation therapy on dysphagia and trismus in NPC patients | Clinical assessment of swallowing and jaw opening | Rehabilitation training can improve swallow function and slow down the progress of trismus in NPC patients | 3/5 |
| Wang et al30 | 12(3F:9M) | 52.58 ± 10.82 | Not available | RT only (12) | Evaluate the effect of cervical esophagostomy in NPC patients with severe dysphagia | QoL measures, incidence of pneumonia | Cervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma | 4/5 |
NPC: nasopharyngeal cancer; MMAT: Mixed Methods Appraisal Tool; IMRT: intensity modulated radiation therapy; RT: radiation therapy; FEES: fiberoptic endoscopic evaluation of swallowing; RTOG: Radiation Therapy Oncology Group; EORTC: European Organization for Research and Treatment of Cancer; MDADI: MD Anderson Dysphagia Inventory; C/RT: chemo-radiation therapy; VFSS: videofluoroscopic swallowing study; QoL: quality of life; NMES: neuromuscular electrical stimulation.