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. 2025 Apr 16;32(4):233.
doi: 10.3390/curroncol32040233.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients with Late Radiation-Associated Dysphagia: Swallowing Safety, Efficacy, and Dysphagia Phenotype

Marco Gitto  1   2 , Francesco Mozzanica  3   4 , Vincenzo Porpiglia  1 , Luca Morelli  1 , Aurora Ninfa  1   2 , Alessandro Selvagio  1   2 , Sara Rocca  1   2 , Nicole Pizzorni  1   2 , Antonio Schindler  1   2
Affiliations

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients with Late Radiation-Associated Dysphagia: Swallowing Safety, Efficacy, and Dysphagia Phenotype

Marco Gitto et al. Curr Oncol. .

Abstract

Late radiation-associated dysphagia (late-RAD) remains a challenge in head and neck cancer (HNC) survivorship, despite advancements in treatment methods. Although Fiberoptic Endoscopic Evaluation of Swallowing (FEES) stands as the preferred diagnostic approach for oropharyngeal dysphagia assessment in the HNC population, current studies lack a FEES-derived swallowing parameter characterization and phenotypic classification within this specific cohort. This study sought to employ FEES-based assessment to characterize swallowing safety and efficacy profiles, identify distinct phenotypes in HNC patients suffering from late-RAD, and examine potential correlations between safety and efficacy parameters. A retrospective analysis included twenty-four post-radiotherapy HNC patients evaluated using standardized FEES protocols across three bolus consistencies (liquid, semisolid, and solid). Swallowing safety was quantified using the Penetration-Aspiration Scale (PAS), while efficacy was measured via the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Additionally, six distinct dysphagia phenotypes were characterized within the cohort. Propulsion deficit was the predominant phenotype (92%), followed by delayed pharyngeal phase (37.5%) and protective deficit (25%), with 46% of patients exhibiting multiple phenotypes. Unsafe swallowing occurred most frequently with liquid consistency (62.5%), while residue was most prevalent with semisolid (82.6% valleculae, 52.2% pyriform sinuses) and solid consistencies (92.3% valleculae, 53.8% pyriform sinuses). Significant correlations were found between penetration-aspiration and pharyngeal residue scores across consistencies (p < 0.05). FEES examination revealed distinct phenotypes in late radiation-associated dysphagia, with a predominance of propulsion deficit and significant interdependence between safety and efficacy parameters.

Keywords: dysphagia phenotypes; fiberoptic endoscopic evaluation of swallowing; head and neck cancer; radiation-associated dysphagia; swallowing efficacy; swallowing safety.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
FOIS score before (FOIS in) and after (FOIS out) the Fiberendoscopic Evaluation of Swallowing Evaluation.
Figure 2
Figure 2
Dysphagia phenotypes in the total cohort. The results are reported as percentages.
Figure 3
Figure 3
Distribution of the Penetration–Aspiration Scale (PAS) scores in the cohort of patients.
Figure 4
Figure 4
(A) Distribution of the Yale (B) Pharyngeal Residue Rating Scale (YALE) valleculae (v) and pyriform sinuses (ps) scores obtained from the cohort of patients.
See this image and copyright information in PMC

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