David J Sher1, Jingsheng Yan2, Andrew Day3, Baran D Sumer3, Nhat-Long Pham4, Saad Khan5, Hong Zhu2. 1. Department of Radiation Oncology and Division of Outcomes and Health Services Research, UT Southwestern Medical Center, Dallas, TX, USA. Electronic address: david.sher@utsouthwestern.edu. 2. Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA. 3. Department of Otolaryngology-Head & Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA. 4. Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA. 5. Department of Medical Oncology, UT Southwestern Medical Center, Dallas, TX, USA.
Abstract
OBJECTIVES: To determine the comparative effectiveness of primary radiotherapy (RT) and primary surgery (PS) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS: Eligible individuals were patients in the SEER-Medicare registry diagnosed with locally advanced OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT ± chemotherapy, or PS ± adjuvant RT or chemoradiotherapy (CRT). Overall survival (OS) was analyzed using Cox multivariable analysis (MVA). Risks of gastrostomy dependence (GD), esophageal stricture (ES), and osteoradionecrosis (ORN) were analyzed using logistic regression. RESULTS: A total of 2754 patients (69% RT, 31% PS) were included in this cohort, with a median age of 72 years. Patients treated with RT, CRT and PS experienced 3-year OS outcomes of 36.1%, 52.8%, and 54.9%, respectively (p < 0.001). Increasing age, unmarried status, increasing comorbidity, lower income, base of tongue (BOT) site, higher stage, no prior PET, and RT alone (but not CRT) were associated with inferior OS. Independent predictors of GD at 6 months included black race, BOT site, advanced stage, and CRT. The risks of ORN and stricture were not associated with treatment modality. Concurrent chemotherapy improved OS with definitive RT but had no impact in adjuvant RT. Only cisplatin- and taxane-containing regimens improved OS, but all concurrent agents, including cetuximab, significantly worsened GD. CONCLUSION: Local therapy decisions for locally advanced OPSCC must be individualized, with CRT increasing acute and chronic GD. The differential survival impact of concurrent chemotherapy in the definitive and adjuvant setting may be a consideration in decision-making.
OBJECTIVES: To determine the comparative effectiveness of primary radiotherapy (RT) and primary surgery (PS) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS: Eligible individuals were patients in the SEER-Medicare registry diagnosed with locally advanced OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT ± chemotherapy, or PS ± adjuvant RT or chemoradiotherapy (CRT). Overall survival (OS) was analyzed using Cox multivariable analysis (MVA). Risks of gastrostomy dependence (GD), esophageal stricture (ES), and osteoradionecrosis (ORN) were analyzed using logistic regression. RESULTS: A total of 2754 patients (69% RT, 31% PS) were included in this cohort, with a median age of 72 years. Patients treated with RT, CRT and PS experienced 3-year OS outcomes of 36.1%, 52.8%, and 54.9%, respectively (p < 0.001). Increasing age, unmarried status, increasing comorbidity, lower income, base of tongue (BOT) site, higher stage, no prior PET, and RT alone (but not CRT) were associated with inferior OS. Independent predictors of GD at 6 months included black race, BOT site, advanced stage, and CRT. The risks of ORN and stricture were not associated with treatment modality. Concurrent chemotherapy improved OS with definitive RT but had no impact in adjuvant RT. Only cisplatin- and taxane-containing regimens improved OS, but all concurrent agents, including cetuximab, significantly worsened GD. CONCLUSION: Local therapy decisions for locally advanced OPSCC must be individualized, with CRT increasing acute and chronic GD. The differential survival impact of concurrent chemotherapy in the definitive and adjuvant setting may be a consideration in decision-making.
Authors: Luise Klapper; Christian Idel; Patrick Kuppler; Tobias Jagomast; Amelie von Bernuth; Karl-Ludwig Bruchhage; Dirk Rades; Anne Offermann; Jutta Kirfel; Sven Perner; Julika Ribbat-Idel Journal: J Pers Med Date: 2022-06-17
Authors: Julika Ribbat-Idel; Sven Perner; Patrick Kuppler; Luise Klapper; Rosemarie Krupar; Christian Watermann; Finn-Ole Paulsen; Anne Offermann; Karl-Ludwig Bruchhage; Barbara Wollenberg; Christian Idel Journal: Front Med (Lausanne) Date: 2021-01-27
Authors: Finn-Ole Paulsen; Christian Idel; Julika Ribbat-Idel; Patrick Kuppler; Luise Klapper; Dirk Rades; Karl-Ludwig Bruchhage; Barbara Wollenberg; Johannes Brägelmann; Sven Perner; Anne Offermann Journal: Int J Mol Sci Date: 2020-07-31 Impact factor: 5.923