Studying Radiation-Associated Dysphagia in Head and Neck Cancer Patients

Contact Information
(608) 263-0192
UW Health Services
Clinical Trial to "Save the Swallow"
MADISON - Surgery has long been the preferred treatment for neck or throat cancers, but it came at an undesirable cost - to save their lives, patients often lost their native voice or ability to swallow after extensive surgery.
Around 15 years ago, innovations in radiation and chemotherapy seemed to reduce that tradeoff. Though cure rates stayed the same, 40 percent of patients retained their ability to speak after treatment.

New therapies, however, carry new risks. Studies have shown up to 70 percent of head and neck cancer patients treated with radiation therapy report moderate to severe dysphagia, interrupting their abilities to eat or drink. UW Health otolaryngology chair and head and neck surgeon Timothy McCulloch, MD, is examining ways those patients can regain their ability to swallow.

"Many tumors in the voice box and throat are very susceptible to radiation, which makes it an effective tool for head and neck cancers," Dr. McCulloch says. "Unfortunately, the treatments can prevent the mucosal tissue from replenishing and healing, leading to stiffer tissue, scar banding and muscles that don't move as they should - or at all."

Timothy McCulloch, MD

Timothy McCulloch, MD

As part of an NIH-funded study led by Boston University, Dr. McCulloch is studying the effect of neuromuscular electrical stimulation on swallowing muscles in patients with radiation-associated dysphagia. Stimulation is provided in low-dose cycles via electrodes the patient places under his or her chin at home, causing the muscles to contract while swallowing.

The randomized clinical trial compares results of aggressive exercise plus electrical stimulation versus exercise alone, with the electrodes providing monitoring and guidance for the exercise therapy. Dr. McCulloch says that anecdotal evidence suggests that the benefit may occur with either approach, and this study will give a clearer idea of whether or not that is true.

"Patients in both groups will place the electrodes, but one will get monitoring and the low-dose stimulation, while the other will just get the monitoring and guidance," he says.

Dysphagia Study Requirements
Patients who have received radiation therapy for cancer of the head and neck within the past three to six months and are experiencing some level of dysphagia are eligible for this study.
Participants will be seen for a videofluoroscopic swallow study and if eligible to continue, will be trained to use the electrode device in addition to having their swallow tested at the beginning, middle and end of a three-month period. Follow-up therapies will also be available as well.

"The key to the study, as well as the treatment, is patients who are motivated and independent in their therapy," Dr. McCulloch says. "It's uncertain how broad a benefit neuromuscular electrical stimulation may have, but with patients dedicated to improving their swallow function, we have a good chance of finding out."

For more information about the dysphagia study or to refer a patient, contact Timothy McCulloch, MD, at (608) 263-0192.
Date published: 4/28/2008