Longitudinal Patterns of Radiation-Associated Dysphagia in Patients With Head and Neck Cancer: A Systematic Review

Abstract

Objective: To investigate the diagnostic profile of early (i.e., < 6 months of treatment) and late (i.e., ≥ 6 months of treatment) radiation-associated dysphagia (RAD) in patients with head and neck cancer. Materials and Methods: The literature was queried from inception to July 19, 2024. Outcomes included patient-reported outcome measures, aspiration prevalence, pharyngoesophageal stricture rate, and gastric tube presence. Data were collected at various time points from baseline up to 24 months post-treatment; longer-term data beyond 24 months was descriptively summarized. Meta-analysis of continuous measures (mean) and proportions (%) with 95% confidence intervals (CI) was performed. Results: Of 2881 abstracts identified, 99 studies (N = 15 578 patients) were included. Mean age was 58.4 years; 78.9% of patients were male. M.D. Anderson Dysphagia Inventory composite scores were 71.2 (CI: 66.8–75.6) at 3 months and 82.8 (CI: 79.2–86.3) at 24 months, signifying improvement in swallowing-related quality of life. Aspiration prevalence was 28.4% (CI: 11.6–49.1) at 3 months and 8.8% (CI: 0.13–28.7) at 24 months. Stricture rate was 21.2% (CI: 9.7–15.2) at 6 months and 9.1% [CI: 3.0–17.9] at 24 months. Gastric tube presence declined from baseline (44.5% [CI: 36.8–52.4]) to 6 months (12.3% [CI: 9.7–16.6]) and fluctuated from 1 to 10 years post-treatment (range: 4.14% [CI: 2.7–5.9] to 9.17% [CI: 5.5–14.2]). Conclusion: RAD severity peaks within 3 months post-treatment, with improvement by 6 months. However, even at 2 years post-treatment, a substantial number of patients continue to experience clinically significant dysphagia. These findings highlight the persistent burden of RAD, underscoring the need for proactive longer-term dysphagia evaluation and management in this population.