***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: 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 To assess toxicities , functional outcomes , and health-related quality of life associated with concurrent chemoradiation therapy ( CRT ) in patients with head and neck cancer . DESIGN Prospect i ve and retrospective outcomes study . SETTING Tertiary care institution . PATIENTS Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1 , 2000 , and March 1 , 2007 ( n = 104 ) . INTERVENTIONS Patients prospect ively provided functional and health-related quality of life information , including data from the 1-year and most current follow-up visits . Medical records were review ed to determine toxicity and survival rates . MAIN OUTCOME MEASURES Well-defined acute and late toxicities ; functional outcomes ( diet , dentition , tracheostomies ) ; head and neck cancer-specific , general health , and depression outcomes ; and survival rates . RESULTS Most patients had oropharyngeal or laryngeal tumors ( 87.5 % ) and advanced-stage disease ( 75.0 % ) . Approximately one-half had hematologic toxicities and toxicity-related treatment delays . Approximately one-quarter had neurotoxicities and /or ototoxicites , moist desquamation , pneumonia , nausea and vomiting requiring hospitalization or intravenous fluids , dehydration or malnutrition requiring hospitalization , and mild or moderate fever . Although patients receiving the current intensity-modulated radiation therapy ( IMRT ) protocol using the Pinnacle(3 ) planning system had more toxicity-related treatment delays , they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system . CONCLUSIONS Patients receiving CRT  experience a substantial number of treatment-related adverse events , primarily affecting oropharyngeal and laryngeal function , with improvement noted for the current IMRT protocol . Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes OBJECTIVE To evaluate changes in patient-perceived swallowing function over time following transoral robotic surgery ( TORS ) for primary T1 and T2 oropharyngeal squamous cell carcinomas . DESIGN Prospect i ve case series . SETTING Academic tertiary referral center . PATIENTS Forty-two patients with T1 or T2 oropharyngeal squamous cell carcinomas . INTERVENTION TORS-assisted resection of indicated tumors . MAIN OUTCOME MEASURES Changes in patient-perceived swallowing function over time ( using the M. D. And erson Dysphagia Inventory ) and gastrostomy tube dependence . RESULTS Between March 19 , 2007 , and April 21 , 2010 , forty-two patients with primary T1 or T2 oropharyngeal squamous cell carcinomas underwent TORS-assisted resection . Most ( 76 % [ 32 of 42 ] ) patients had stage III disease ; 93 % ( 39 of 42 ) of patients underwent staged neck dissection . The median postoperative follow-up time was 17 months ( range , 4 - 40 months ) . There were no complications or tumor recurrences . Postoperative chemotherapy use predicted gastrostomy tube retention for longer than 3 months ( P = .01 ) . Immediate mean postoperative M. D. And erson Dysphagia Inventory scores in each assessed domain ( global , emotional , physical , and functional ) decreased compared with preoperative baseline scores ; however , ongoing improvement in all domains was observed over time . Nodal status ( P = .049 ) , follow-up time of less than 12 months ( P = .03 ) , and preoperative physical scores of less than 100 ( P = .01 ) predicted poorer physical M. D. And erson Dysphagia Inventory outcomes . Positive pathological margins predicted poorer functional scores ( P = .03 ) . CONCLUSIONS After TORS-assisted resection of T1 and T2 oropharyngeal squamous cell carcinomas , approximately one-third of patients will experience a sustained decrease in perceived swallowing function . However , ongoing improvement of swallowing function over time is likely even after 12 months . Patients receiving adjuvant chemotherapy  after TORS should be counseled about the possibility of prolonged gastrostomy tube dependence BACKGROUND AND PURPOSE To prospect ively investigate the impact of different patients ' characteristics on quality -of-life ( QoL )  after (chemo)radiation for oropharyngeal cancer ( OPC ) . MATERIAL S AND METHODS Between 2008 and 2011 , 207 patients were treated with 46-Gy of (chemo)-IMRT followed by a boost by means of IMRT , brachytherapy ( BT ) , or Cyberknife ( CK ) .  QoL- assessment was performed using the EORTC QLQ-C30 , and QLQ-H&N35- question naires at baseline , end of treatment , 2 , 4 , 6 weeks and 3 , 6 , 12 , and 18 months after treatment . The correlation between patients ' characteristics ( AJCC-stage , tumor subsite , chemotherapy , neck dissection , unilateral neck irradiation , and boost technique ) , and changes in QoL over time were investigated . RESULTS At 18months , improvements were seen in QLQ-C30 emotional functioning , insomnia , and pain and QLQ-H&N35 pain and speech . The scores on QLQ-H&N35 swallowing returned to baseline level while the scores on dry mouth , sticky saliva , opening mouth , and teeth were significantly deteriorated compared to baseline . Boost techniques and unilateral neck irradiation were significantly predictive for dry mouth , swallowing and opening mouth while chemotherapy was correlated with changes on swallowing and opening mouth scales . CONCLUSIONS The most significant deterioration was seen in patient-related xerostomia . Boost technique , unilateral neck irradiation and chemotherapy were significantly predictive for QoL-changes over time Background The incidence of oropharyngeal squamous cell carcinoma ( OPSCC ) has markedly increased over the last three decades due to newly found associations with human papillomavirus ( HPV ) infection . Primary radiotherapy ( RT ) is the treatment of choice for OPSCC at most centers , and over the last decade , the addition of concurrent chemotherapy has led to a significant improvement in survival , but at the cost of increased acute and late toxicity . Transoral robotic surgery ( TORS ) has emerged as a promising alternative treatment , with preliminary case series demonstrating encouraging oncologic , functional , and quality of life ( QOL ) outcomes . However , comparisons of TORS and RT in a non-r and omized fashion are susceptible to bias . The goal of this r and omized phase II study is to compare QOL , functional outcomes , toxicity profiles , and survival following primary RT ( ± chemotherapy ) vs. TORS ( ± adjuvant [ chemo ] RT ) in patients with OPSCC . Methods / Design The target patient population comprises OPSCC patients who would be unlikely to require chemotherapy post-resection : Tumor stage T1-T2 with likely negative margins at surgery ; Nodal stage N0 - 2 , ≤3 cm in size , with no evidence of extranodal extension on imaging . Participants will be r and omized in a 1:1 ratio between Arm 1 ( RT ± chemotherapy ) and Arm 2 ( TORS ± adjuvant [ chemo ] RT ) . In Arm 1 , patients with N0 disease will receive RT alone , whereas N1 - 2 patients will receive concurrent chemoradiation . In Arm 2 , patients will undergo TORS along with selective neck dissections , which may be staged . Pathologic high-risk features will be used to determine the requirement for adjuvant radiotherapy + /- chemotherapy . The primary endpoint is QOL score using the M.D. And erson Dysphagia Inventory ( MDADI ) , with secondary endpoints including survival , toxicity , other QOL outcomes , and swallowing function  . A sample of 68 patients is required . Discussion This study , if successful , will provide a much-needed r and omized comparison of the conventional strategy of primary RT vs. the novel strategy of primary TORS . The trial is design ed to provide a definitive QOL comparison between the two arms , and to inform the design of an eventual phase III trial for survival outcomes .Trial registration BACKGROUND The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by " risk-based " local therapy for locally-advanced squamous cell carcinoma of the head and neck ( SCCHN ) . METHODS Forty-seven patients ( stage IV ; ≥N2b ) were enrolled in a phase II trial . Baseline and 24-month functional measures included modified barium swallow ( MBS ) studies , oropharyngeal swallow efficiency ( OPSE ) , and the MD And erson Dysphagia Inventory ( MDADI ) . Functional status was assessed at 5 years . RESULTS Five-year overall survival ( OS ) was 89 % ( 95 % confidence interval [ CI ] , 81 % to 99 % ) . A nonsignificant 13 % average reduction in swallowing efficiency ( OPSE ) was observed at 24 months relative to baseline ( p = .191 ) . MDADI scores approximated baseline at 24 months . Among 42 long-term survivors ( median , 5.9 years ) , 3 patients ( 7.1 % ) had chronic dysphagia . The rate of final gastrostomy dependence was 4.8 % ( 2 of 42 ) . CONCLUSION Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN , mainly of oropharyngeal origin . MBS and MDADI scores found modest swallowing deterioration at 2 years , and chronic aspiration was uncommon in long-term survivors The aim of this study was to evaluate the long-term quality of life ( QoL ) in survivors with oropharyngeal carcinoma ( OC ) treated with surgery and postoperative radiotherapy ( PORT ) versus concurrent chemoradiation ( CRT )  using the European Organization for Research and Treatment of Cancer QoL Question naires . The study group consisted of 57 patients . The scores for physical ( P=0.043 ) and social ( P=0.036 ) functioning were significantly more favorable in the chemoradiation group . Surgical patients showed statistically higher problems with fatigue ( P=0.047 ) , pain ( P=0.027 ) , swallowing ( P=0.042 ) , social eating ( P=0.038 ) and social contact ( P=0.002 ) . CRT group reported significantly greater problems with teeth ( P=0.049 ) , open mouth ( P=0.036 ) , dry mouth ( P=0.022 ) and sticky saliva ( P=0.044 ) . The global QoL score was higher in CRT group ( P=0.027 ) . These results support an organ preservation approach with CRT in patients with advanced OC . However , considering the absence of r and omized trial comparing outcomes after surgical versus nonsurgical approaches , severe xerostomia following CRT , the higher postoperative morbidity in the setting of salvage surgery , future prospect i ve clinical trials on greater sample s of patients are needed to confirm our conclusions Introduction 
    Output:
    
From the current evidence , no direct comparisons could be made of swallowing outcomes between the surgical and non-surgical modalities .
The MD And erson Dysphagia Inventory is a subjective measure that allows limited comparison between the currently available heterogeneous data , and is explored in detail .