I have posted often in the may threads on swallowing issues and PEG tubes about something that everyone seems to ignore in the equation when it comes to dysphagia, or swallowing difficulties at the end of treatment. That is radiation exposure to the muscles and nerves that control it all.

While this is pretty well understood, a German oncology journal published an article this month stating that there was a direct correlation between the amount of radiation that these sensitive structures get and long-term swallowing issues.

Posters in past threads often talking about losing the "swallowing memory" after becoming dependent on a PEG, but that does not account for the many people that have had no dysphagia after being on PEGs for protracted periods of time. Indeed people both with and without PEGs end up with swallowing issues and the constancy of who has problems and who does not, cannot be tied to getting a PEG alone. It has everything to do with radiation exposure, angles of exposure, and where the primary is located, which yields a greater or lesser level of radiation to these sensitive areas.

http://oralcancernews.org/wp/dysphagia-after-definitive-radiotherapy-for-head-and-neck-cancer/