***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Postsurgical oral and oropharyngeal cancer patients may experience pharyngeal clearance problems after completion of postoperative radiotherapy OBJECTIVE To design a reliable and vali date d self-administered question naire whose purpose is to assess dysphagia 's effects on the quality of life ( QOL ) of patients with head and neck cancer . DESIGN Cross-sectional survey study . METHODS Focus groups were convened for question naire development and design . The M. D. And erson Dysphagia Inventory ( MDADI ) included global , emotional , functional , and physical subscales . One hundred consecutive adult patients with a neoplasm of the upper aerodigestive tract who underwent evaluation by our Speech Pathology team completed the MDADI and the Medical Outcomes Study 36-Item  Short Form Health Survey  ( SF-36 ) . Speech pathologists completed the Performance Status Scale for each patient . Validity and reliability properties were calculated . Analysis of variance was used to assess how well the MDADI discriminated between groups of patients . RESULTS The internal consistency reliability of the MDADI was calculated using the Cronbach alpha coefficient . The Cronbach alpha coefficients of the MDADI subscales ranged from 0.85 to 0.93 . Test-retest reliability coefficients of the subscales ranged from 0.69 to 0.88 . Spearman correlation coefficients between the MDADI subscales and the SF-36 subscales demonstrated construct validity . Patients with primary tumors of the oral cavity and oropharynx had significantly greater swallowing disability with an adverse impact on their QOL compared with patients with primary tumors of the larynx and hypopharynx ( P<.001 ) . Patients with a malignant lesion also had significantly greater disability than patients with a benign lesion ( P<.001 ) . CONCLUSIONS The MDADI is the first vali date d and reliable self-administered question naire design ed specifically for evaluating the impact of dysphagia on the QOL of patients with head and neck cancer . St and ardized question naires that measure patients ' QOL offer a means for demonstrating treatment impact and improving medical care . The development and validation of the MDADI and its use in prospect i ve clinical trials allow for better underst and ing of the impact of treatment of head and neck cancer on swallowing and of swallowing difficulty on patients ' QOL OBJECTIVE RADPLAT ( concurrent selective supradose intraarterial cisplatin and external-beam irradiation ) delivers extraordinarily high cisplatin concentration to head and neck structures . This study was design ed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech . METHODS Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT  were compared with 16 treated with systemic chemoradiation  1 month after treatment . RESULTS RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures , and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals . Speech function was comparable except for RADPLAT 's significantly worse /s , z/ productions . CONCLUSIONS Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function BACKGROUND We performed a prospect i ve , r and omized study in patients with previously untreated advanced ( Stage III or IV ) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation . METHODS Three hundred thirty-two patients were r and omly assigned to receive either three cycles of chemotherapy ( cisplatin and fluorouracil ) and radiation therapy or surgery and radiation therapy . The clinical tumor response was assessed after two cycles of chemotherapy , and patients with a response received a third cycle followed by definitive radiation therapy ( 6600 to 7600 cGy ) . Patients in whom ther was no tumor response or who had locally recurrent cancers after chemotherapy and radiation therapy underwent salvage laryngectomy .  RESULTS After two cycles of chemotherapy , the clinical tumor response was complete in 31 percent of the patients and partial in 54 percent . After a median follow-up of 33 months , the estimated 2-year survival was 68 percent ( 95 percent confidence interval , 60 to 76 percent ) for both treatment groups ( P = 0.9846 ) . Patterns of recurrence differed significantly between the two groups , with more local recurrences ( P = 0.0005 ) and fewer distant metastases ( P = 0.016 ) in the chemotherapy group than in the surgery group . A total of 59 patients in the chemotherapy group ( 36 percent ) required total laryngectomy . The larynx was preserved in 64 percent of the patients overall and 64 percent of the patients who were alive and free of disease . CONCLUSIONS These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients , without compromising overall survival PURPOSE To prospect ively evaluate performance and quality of life ( QOL ) in advanced-stage head and neck cancer ( HNC ) patients on a curative-intent , concomitant-chemoradiotherapy ( CT/XRT ) ( twice-daily radiation , fluorouracil , hydroxyurea , and cisplatin ) regimen aim ed at improving locoregional control , survival , and QOL . PATIENTS AND METHODS Sixty-four patients were assessed before , during , and at 3-month intervals after treatment . St and ardized measures of QOL ( Functional Assessment of Cancer Therapy-Head and Neck ) , performance ( Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale ) , and patient-reported symptoms ( McMaster University Head and Neck Radiotherapy Question naire ) were administered . RESULTS Acute treatment toxicities were severe , with declines in virtually all QOL and functional domains . Marked improvement was seen by 12 months ; general functional and physical measures returned to baseline levels of good to excellent . Although up to a third of the patients continued to report problems with swallowing , hoarseness , and mouth pain , these difficulties were present in similar magnitudes before treatment . The following symptoms were more frequent at 12 months : dry mouth ( 58 % v 17 % ) , difficulties tasting ( 32 % v 8 % ) , and soft food diet ( 82 % v 42 % ) . Twelve-month diet was not related to pretreatment functioning , disease , treatment , or patient characteristics . Twelve-month QOL was best predicted by pretreatment QOL , with very little relationship to residual side effects or functional impairments . Small numbers of patients in four of the five disease sites precluded examination of outcome by site . CONCLUSION These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC . Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months . The persistent inability to eat a full range of foods warrants further attention and monitoring OBJECTIVE To evaluate the long-term effects on swallowing function of concomitant continuous infusion hydroxyurea and hyperfractionated radiation therapy used to treat advanced head and neck carcinoma . DESIGN A prospect i ve evaluation of swallowing function was performed on an inception cohort by analyzing posttreatment videoflouroscopic swallow function studies using radiological descriptors for pharyngeal transport abnormalities and temporal measures of structural movements , as well as by conducting patient interviews to assess alimentation , more than 1 year after tumor treatment ( range , 52 - 124 weeks ; median , 70 weeks ) . SETTING Academic tertiary care referral medical center . PATIENTS Ten patients , aged 44 to 71 years , with stage III and IV squamous cell carcinoma of the oral cavity , oropharynx , or hypopharynx . MAIN OUTCOME MEASURE Radiographic and temporal swallow abnormalities , as well as functional status , were documented and compared with published norms and results of earlier swallowing studies when possible . RESULTS Pharyngeal transport dysfunction and anterior segment abnormalities , manifested by epiglottic dysmotility , vallecular residue , laryngeal penetration , or aspiration , were evident in all 10 patients . Posterior segment abnormalities , such as pharyngeal stasis , constrictor dysmotility and piriform residue were documented in 8 patients . Three patients developed late aspiration , and the majority of patients showed persistent or worsened delay in laryngeal movement compared with their earlier posttreatment evaluations . Also , 3 patients developed a hypopharyngeal stricture , and 6 patients continued to require gastrostomy tube supplementation beyond 1 year . There was no association between site of primary , duration to swallowing evaluation , and severity of dysfunction . CONCLUSION Prolonged and debilitating functional swallowing abnormalities may occur after this aggressive concomitant chemotherapy and radiotherapy regimen OBJECTIVE To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment . DESIGN Prospect i ve case series . SETTING Tertiary care referral center . PATIENTS A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated , accelerated radiotherapy .  INTERVENTIONS Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems , prompting a dose reduction to 60.0 Gy . Eighteen patients were followed up for this study in the  74.4-Gy group , while 11 were in the 60.0-Gy group . MAIN OUTCOME MEASURES Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy . RESULTS Patient demographics and tumor characteristics were similar in each group , while significant differences were noted in the posttreatment clinical swallowing variables . Persistent severe odynophagia at 4 months ( 89 % [ 16/18 ] vs 30 % [ 3/10 ] ) and at 12 months ( 64 % [ 7/11 ] vs 11 % [ 1/9 ] ) was greater in the 74.4-Gy group ( P = .002 ) . Clinical signs of aspiration were also increased in the 74.4-Gy group , with 81 % ( 13/16 ) vs 11 % ( 1/9 ) at 4 months and 60 % ( 6/10 ) vs 11 % ( 1/9 ) at 12 months ( P<.05 ) . Most striking , however , was the incidence of long-term gastrostomy , with 78 % ( 14/18 ) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18 % ( 2/11 ) in the 60.0-Gy group ( P = .002 ) . Local control was unchanged by the altered dosing , with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups , respectively . CONCLUSION Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications PURPOSE The purpose of this study was to develop and vali date an instrument for clinical trials to measure radiation-related acute morbidity and quality of life from the perspective of patients with head and neck cancer ( HNC ) treated with radiotherapy . METHODS The Head and Neck Radiotherapy Question naire ( HNRQ ) was developed by a panel of health care workers and patients , was pretested in a pilot study of HNC patients , and was vali date d in a r and omized double-blind trial of concomitant fluorouracil ( FUra ) infusional therapy ( 1.2 g/m2 per 24 hours ) or saline placebo administered for 72 hours in the first and third weeks of a 6 1/2-week course of radiation therapy . The HNRQ was vali date d against existing toxicity and performance status indices , all of which were measured weekly for the 6 1/2 weeks of treatment and for 4 weeks posttreatment . RESULTS There were three a priori constructs : ( 1 ) that the HNRQ scores would conform to a shallow U-shaped pattern to reflect declining quality of life ( increasing morbidity ) during radiation and recovery posttreatment ; ( 2 ) that the HNRQ would correlate with existing toxicity indices ( World Health Organization [ WHO ] stomatitis , Byfield stomatitis , WHO skin toxicity , Eastern Cooperative Oncology Group [ ECOG ] and Karnofsky performance status ) ; and ( 3 ) that the HNRQ would discriminate between FUra and placebo groups . The HNRQ and its domain scores all showed a change from baseline reflecting increased morbidity during radiation ( analysis of variance [ ANOVA ] , P < .00001 ) . The HNRQ correlated well with all other indices ( r > or = .60 ) , and domain scores correlated best with other indices that assess the same symptom complex ( eg , HNRQ skin domain and WHO skin toxicity index , r = .77 ) . There was a significant difference in HNRQ scores between the FUra and placebo groups during radiation ( ANOVA , P = .0007 ) , and all HNRQ domains also discriminated between the treatment groups . CONCLUSION The HNRQ is a valid measure of acute morbidity due to radiation therapy in patients with locally advanced HNC , and may be useful as an outcome 
    Output:
    
Method ological quality was found to be compromised in most studies .
Although many research ers had investigated swallowing impairment , a wide variety of measurement tools were employed .
There are limited data on swallowing outcomes after  radiotherapy or chemoradiotherapy  for head and neck cancer .