Ultrasound-guided, nursing-led, phase-based swallowing rehabilitation in elderly patients with MIBG-positive medullary thyroid carcinoma following 131I-MIBG therapy.

BACKGROUND

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy originating from parafollicular C cells and often requires multimodal management, including surgery, targeted therapy, and radionuclide treatment. In elderly patients with MIBG-positive disease, 131I-MIBG therapy remains clinically valuable but is frequently associated with mucosal injury and neuromuscular dysfunction, resulting in dysphagia and malnutrition. Conventional swallowing rehabilitation often provides limited benefit in this population, underscoring the need for individualized, technology-assisted approaches. This study evaluated the association between ultrasound-guided, nursing-led, phase-based swallowing rehabilitation and clinical outcomes in elderly patients with MIBG-positive MTC following 131I-MIBG therapy.

MATERIALS AND

METHODS

This retrospective observational study analyzed 80 patients aged ≥65 years with post-therapy dysphagia (EAT-10 ≥ 3). Based on routine clinical practice, patients were categorized into a conventional rehabilitation group (n = 40) and an ultrasound-guided rehabilitation group (n = 40). Rehabilitation data over an eight-week period were analyzed. Outcomes included the Functional Oral Intake Scale (FOIS), MD Anderson Dysphagia Inventory (MDADI), EAT-10, ultrasound-derived suprahyoid muscle thickness and hyoid displacement, nutritional indices, aspiration events, and pneumonia-related readmissions.

RESULTS

The ultrasound-guided rehabilitation group demonstrated significantly greater improvements in FOIS (+2.1 ± 0.5 vs. + 1.2 ± 0.6; p < 0.001), MDADI (+32% vs. + 18%; p < 0.001), and EAT-10 (-6.8 ± 2.1 vs. - 3.4 ± 1.9; p < 0.001). Ultrasound parameters showed marked increases in suprahyoid muscle thickness (+24%) and hyoid displacement (+19%). Compared with the conventional rehabilitation group, aspiration events decreased from 15 to 9%, and pneumonia-related readmissions declined from 15 to 5%. No rehabilitation-related adverse events were observed.

CONCLUSION

Participation in ultrasound-guided, nursing-led, phase-based swallowing rehabilitation was associated with significant improvements in swallowing function, muscle performance, nutritional status, and quality of life in elderly patients with MIBG-positive MTC after 131I-MIBG therapy. This approach appears safe, feasible, and scalable for geriatric oncology rehabilitation.