ArticleHead & neck2026
Longitudinal Swallowing and Salivary Changes With CLR 131 and Re-Irradiation in Recurrent Head and Neck Cancer.
Article in Head & neck, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with recurrent head and neck cancer (HNC) often present with severe, persistent dysphagia and xerostomia following prior chemoradiation. Although swallowing impairments and salivary dysfunction have been reported in this population, prior longitudinal studies have not examined changes in salivary composition or how these changes relate to swallowing physiology. PURPOSE: This study characterized longitudinal changes in swallowing and salivary function-including composition-following treatment with CLR 131, a novel tumor-selective radiotherapeutic, combined with external beam radiation therapy (EBRT).
methodsTwelve patients with locoregionally recurrent HNC demonstrating CLR 131 uptake on SPECT/CT imaging were enrolled. Videofluoroscopic swallowing (VFS) studies and stimulated saliva collections were performed at baseline, 3, 6, and 12 months posttreatment. Outcomes included Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores, swallowing temporal measures, patient-reported dysphagia using Eating Assessment Tool (EAT-10), and salivary flow rate, pH, and extensional viscosity.
resultsAt baseline, participants demonstrated significantly worse swallowing and salivary function than published normative data (p < 0.001). Most swallowing measures remained stable following treatment; however, time to laryngeal vestibule closure with 5 mL pudding was prolonged at 3 months (p < 0.02). Stimulated salivary flow rate declined significantly at 12 months (p < 0.001), while pH decreased at 3 months (p < 0.05) and extensional viscosity increased at 6 months (p < 0.02). From baseline to 3 months, EAT-10 scores were strongly associated with salivary pH and viscosity changes (r = 0.84 and -0.99, respectively). No swallowing timing measures predicted DIGEST safety or efficiency grades.
conclusionsThese findings suggest that CLR 131 + EBRT did not exacerbate objective swallowing impairment in the early post-treatment period, but patient-reported dysphagia was sensitive to post-treatment salivary alterations. Integrating salivary assessments with instrumental and patient-reported outcomes may enhance detection of functional toxicity and guide targeted dysphagia management in recurrent HNC.
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