Structural Displacements During the Swallow in Patients with Early Laryngeal Cancers and Other Early Primary Cancers of the Head and Neck

Spatial movement of pharyngeal structures involved in swallowing was assessed by videofluoroscopy in 24 patients with early (T1N0) carcinoma of the larynx prior to curative treatment using an identical radiotherapy regimen (55 Gy in 20 daily fractions), and in 24 patients who had early primary head and neck cancers in other locations that would not be expected to interfere with the pharyngeal swallowing process. There were no significant differences between the laryngeal cancer patients and the other patients. Measurements were generally consistent with previously reported results in volunteers with normal swallows. On univariate analysis, patients ≥70 vs. <70 years old had a significantly greater hyoid-laryngeal distance and pharyngeal area at rest. Patients with body mass index (BMI) ≥26 vs. <26 demonstrated a significantly greater maximal width of the pharyngo-oesophageal sphincter (PES) in the lateral view. Multiple regression revealed that greater hyoid-laryngeal distance at rest and at the point of maximal approximation were the significant predictors of male vs. female gender at the exclusion of all other variables, accounting for 59% of the variance. In no patient did contrast touch the vocal cords during the swallow. This study forms a baseline for future prospective evaluation of the effect of radiotherapy on the swallowing of patients with early laryngeal cancer.