Baş Boyun Kanserli Hastalarda Radyoterapinin Boyun, Omuz Fonksiyonları ve Ağız Açıklığı Üzerine Etkilerinin Değerlendirilmesi

Abstract

Introduction: Treatment of head and neck cancer is a complex process. Patients are treated with surgery, radiotherapy (RT) and/or chemotherapy. Several complications may occur as a consequence of treatment in patients with head and neck cancer. To the best of our knowledge, there has been no prospectively designed study investigating the effect of RT on both neck, shoulder function and mouth opening. The aim of this study was to evaluate neck, shoulder functions and mouth opening in patients receiving RT for head and neck cancer. Materials and Methods: Thirty patients with a diagnosis of head and neck cancer, who were admitted to the department of Radiation Oncology between 22.06.2020 and 15.06.2021 for RT, were included in the study. The patients were evaluated before, immediately after and 3 months after RT. The demographic and clinical characteristics of all patients were recorded. Active and passive neck and shoulder range of motion (ROM) and mouth opening measurements were performed. Visual Analogue Scale (VAS) was used to assess the severity of neck, shoulder and orofacial pain. Pain pressure threshold (PPT) was measured from certain points using an algometer. Neck and shoulder disability was evaluated with the Neck Disability Index and the Shoulder Pain and Disability Index, respectively. Results: Analyzes were performed on 20 patients who had completed all three assessments. The mean age of the patients was 54.6±12.5 years (range, 35-91). Three months after RT, both active (p=0.008) and passive (p=0.03) flexion of the neck were found to be significantly higher than the values of immediately after RT. In comparison with before RT, only active flexion of the left shoulder was lower after 3 months of RT (p=0.013). The mean values of neck disability (p=0.009, p=0.02, respectively) and shoulder disability scores (p=0.002, p=0.01, respectively) immediately and 3 months after RT were significantly higher than before RT. It has been determined that PPT of the head and neck tended to decrease after RT and these difference reached statistically significance after three months. Conclusion: In this study it has been found that neck and shoulder functions, and the values of maximum assisted and unassisted mouth opening were decreased immediately after RT in patients with head and neck cancer, and this deterioration persisted 3 months after RT. In order to reduce these negative effects, early initiation of rehabilitation in the high-risk patients is crucial. Thus, further studies with larger number of patients are warranted to determine the risk factors for the development of neck, shoulder disability and trismus in patients with head and neck cancer.