Swallowing during Radiation
Many patients will have a gastrostomy tube placed routinely prior to starting radiation treatment as it is well known that the treatment will likely result in throat pain, tenderness and swelling. All of these factors can make it difficult and/or undesirable to swallow. Many patients also report a lack of appetite during their treatment and an altered sense of taste can further contribute to this.
Recent studies have shown, however, that t is very important to keep swallowing during the entire course of radiation treatment as well as during the recovery process. Patients who stop taking food/liquid by mouth entirely during their treatment have shown to have a higher incidence of swallowing problem after radiation than those who were able to continue taking in food/liquid during treatment. In this case, the “use it or lose it” principle seems to apply. The regular exercise of the swallowing muscles during treatment helps to preserve their strength and function when compared to those patients who stop swallowing during treatment.
Another important consideration regarding eating during radiation treatment concerns the impact to the esophagus. The esophagus is a flexible muscular tube that contracts, using peristalsis to move material from the throat to the stomach. The upper most portion of the esophagus sits behind the larynx and is within the radiation field during treatment. The esophagus is a thin tube that expands around the food material that is being swallowed and then returns to its normal thin shape after the food passes. If a patient stops eating during radiation, the esophagus does not experience regular expansion or stretching as it does when a patient eats regularly. Instead, it remains narrow, while also receiving large doses of radiation. The fibrosis that results from radiation treatment then affects the esophagus while in this narrow state and the elastic properties it once had are greatly reduced. These patients will frequently require esophageal dilation, perhaps repeatedly, in order to allow for food to pass through the segment exposed in the radiation field. 
Although swallowing and eating during radiation can become difficult and painful, it is important to remember the long-term benefits from swallowing something during the course of every day. The more regular and consistent the swallowing is throughout treatment, the greater the benefit to the throat after radiation is over.
Unfortunately, despite best efforts and intentions to keep eating during radiation, (some even never use the feeding tube at all!), it is possible to still have some complications affecting swallowing anyway. If this is the case, is it important to remember that, regardless of the swallowing difficulty, it would likely be worse or more severe had eating been halted altogether.
by Katrina M. Jensen, Fort Worth, Texas, USA
1. Ahlberg, A; al-Abany M; Alevronta, E; Friesland, S; Helborg, H; Mevroidis, P; Lind, BK; Laurell, G; “Esophageal stricture after radiotherapy in patients with head and neck cancer: experience of a single institution over 2 treatment periods”; Head & Neck. 2010 Apr; 32(4):452—61