[Dysphagia] radiation and dilatation

[tszmansky04 at yahoo.com (Teri Szmansky)]

Hello.  Would love some input.......

I have a pt who is being treated with radiation for lymphoma.  She is 3 weeks in with about 3 weeks remaining.  She has a 15 year hx of Sj?gren's Syndrome and has always had c/o pharyngeal stasis following solid bolus.  She has compensated with a liquid wash and multiple swallows, which was reported to be effective.  Since the onset of radiation, she reports increased residue at the level of the UES and just below with an increased amount of liquid necessary to clear.  In addition, she has had to modify the consistencies to be softer.  I explained to her about the radiation effects and that the opening of the esophagus (UES) is not relaxing, like it should, which is prohibiting the food from passing through.  I provided strategies and diet modifications, explained that it will very likely worsen throughout radiation and with the post radiation effects.  My plan was to follow up with her after radiation, perform a MBSS to determine the extent and amount of residue post
 swallow and determine if this pt should be referred for an esophageal dilatation (which I am sure will be appropriate).  

So...here is my question.  In everyone's experience, when are pts' who are receiving radiation ready for a work up for diatation?  Is it most appropriate to wait until radiation is done?  Is is best to refer this pt for evaluation for dilatation as soon as radiation is completed or wait?  If it is better to wait until post-radiation effects have plateau'd, how long after radiation are your pts receiving dilatation?

I would really appreciate your input on this........thanks.

Teri Szmansky, MACCC-SLP