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Radiation-associated Dysphagia — SCE Medical Oncology MCQ

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ModerateHead & Neck CancerRadiation-associated DysphagiaSCE Medical Oncology

A 70-year-old man with head and neck SCC completes radical chemoradiotherapy. At 6 months post-treatment, he has persistent dysphagia and aspiration requiring PEG feeding. What late toxicity of chemoradiotherapy is he experiencing?

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Correct answer: E — Late radiation-associated dysphagia (RAD)

Late radiation-associated dysphagia (RAD) is the most significant chronic toxicity of H&N chemoradiotherapy, affecting approximately 40-50% of patients. It results from fibrosis of the pharyngeal constrictors, base of tongue and supraglottic larynx. Risk factors include: radiation dose to pharyngeal constrictors (dose constraint <60 Gy), concurrent chemotherapy, bilateral neck treatment and pre-existing dysphagia. Prevention strategies include IMRT (intensity-modulated RT) to spare swallowing structures, and proactive swallowing exercises before, during and after treatment.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer