Videofluoroscopy-Based Aspiration Predicts Subsequent Aspiration Pneumonia

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(ChemotherapyAdvisor) – Videofluoroscopy-based aspiration—especially when associated with a high Penetration-Aspiration score—was highly correlated with subsequent clinical aspiration pneumonia in patients with head and neck cancer treated with chemo-irradiation (CRT), according to a study presented at the 8th International Conference on Head and Neck Cancer, Toronto, Ontario, Canada, July 21-25.

“These patients require close monitoring and rehabilitation by speech/swallow therapists, noted Klaudia U. Hunter, MD, of the University of Michigan, Ann Arbor, MI. “Reducing videofluoroscopy-based aspirations using published dose-effect relationships for the swallowing organs is likely to reduce rates of aspiration pneumonia.”

Videofluoroscopy, or modified barium swallow studies, are used to evaluate dysphagia after CRT; however, clinical relevance has not been reported previously, Dr. Hunter said. In this study, 72 patients with stage III/IV oropharyngeal cancer treated with CRT had videofluoroscopy performed at pretreatment; 3, 12, and 24 months post-CRT; and 4 months posttreatment for those undergoing planned neck dissection.

At each session, “multiple consistencies were tested: thin and thick liquids (5, 10, and 15 mL), pureed food, residue, cookie, and fruit,” she noted, with aspiration on videofluoroscopy defined as material passing beyond the vocal cords. Aspiration events producing no cough response or ineffective response with nonproductive cough were deemed “silent aspiration.”

On videofluoroscopy, aspiration was noted in 7/71 (10%) patients pretreatment; 22/67 (33%) at 3 months posttreatment; 15/65 (23%) at 12 months posttreatment; and 10/57 (18%) at 24 months posttreatment. Nine of 22 patients (40%) who had neck dissection aspirated 4 months posttreatment.

Sixteen patients developed aspiration pneumonia and 12 were hospitalized. Of the 16, 13 showed evidence of aspiration on videofluoroscopy. Clinical factors found to be associated with aspiration pneumonia were current smoking (P=0.04) and tumor stage (P=0.005).

Factors predictive of developing subsequent aspiration pneumonia were aspiration on videofluoroscopy prior to aspiration pneumonia (P=0.003), silent aspiration (P=0.04), and higher Penetration-Aspiration score (P=0.002), Dr. Hunter noted, added that when these factors were combined with tumor stage, the predictive ability of the model improved significantly.

Abstract

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