Unravelling swallowing dysfunction: videofluoroscopic analysis of radiation effects in head and neck cancer

Personalized Radiotherapy: preserving swallowing function in head and neck cancer
Radiotherapy is a key component in treating head and neck cancer. Despite advances in radiation techniques, aspiration- the accidental entry of food or liquid into the airway- remains an often overlooked complication that can have potentially life-threatening consequences, such as aspiration pneumonia. This research focuses on better understanding, predicting, and preventing aspiration after radiotherapy.
To assess aspiration risk, new swallowing structures were defined: the Functional Swallowing Units. These groups of muscles are organized based on their specific role in swallowing, such as lifting the larynx or retracting the tongue base. Using CT and MRI scans, practical guidelines were developed to accurately identify these structures and minimize radiation exposure during treatment.
Videofluoroscopic swallowing examinations revealed that aspiration is relatively common after radiotherapy, yet often goes unnoticed. Based on these findings, predictive models were developed to estimate the risk of aspiration using both radiation dose to specific swallowing structures and individual patient characteristics.
These models enable truly personalized radiotherapy, allowing treatment plans that not only target the tumor effectively but also preserve critical swallowing muscles whenever possible.
This approach represents an important step toward function-preserving, individualized radiotherapy, where tumor control is balanced with maintaining swallowing function and overall quality of life after treatment.