Recovery from Life-Threatening Dysphagia Following Concurrent Chemoradiation for Pyriform Sinus Carcinoma: A One-Year Longitudinal Case Study

Abstract Severe dysphagia is a frequent and debilitating complication following concurrent chemoradiation therapy (CCRT) for hypopharyngeal cancers. Radiation-induced upper esophageal stricture with poor pharyngoesophageal segment (PES) opening is particularly challenging, and recovery to functional oral intake is uncommon. This case documents a full one-year longitudinal course from life-threatening aspiration to safe swallowing after targeted intervention. A 73-year-old man with early-stage squamous cell carcinoma of the left pyriform sinus underwent radiotherapy (66 Gy) with weekly cisplatin. Baseline swallowing was normal, and he maintained a full oral diet. Despite preventive swallowing exercises, he developed severe dysphagia by week four of therapy, necessitating tube feeding. At one month post-treatment, videofluoroscopic swallow study revealed life-threatening aspiration [Penetration–Aspiration Scale (PAS) 8; Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Grade 4] due to poor pharyngoesophageal segment (PES) opening. Intensive swallowing therapy was initiated to enhance laryngeal elevation and PES opening. At three months, fiberoptic endoscopic evaluation of swallowing (FEES) showed persistent secretion pooling, severe post-swallow residue, and subsequent aspiration. At five months, with ongoing therapy, endoscopic serial dilatation of the esophagus to 14 mm was performed. By six months, with continued therapy swallowing safety and efficiency improved markedly, and at 12 months function remained stable [Functional Oral Intake Scale (FOIS) 5; Performance Status Scale–Head and Neck Cancer (PSS-HNC) 50; PAS 2; DIGEST 0], with body weight increasing from 50 kg to 65 kg. This case highlights the importance of early and repeated instrumental swallowing evaluations, the limitations of therapy alone in radiation-related PES dysfunction, and the role of timely endoscopic dilatation in restoring functional swallowing and nutritional status after CCRT for hypopharyngeal carcinoma.