Anthony C Nichols1, Julie Theurer2, Eitan Prisman3, Nancy Read4, Eric Berthelet5, Eric Tran5, Kevin Fung1, John R de Almeida6, Andrew Bayley7, David P Goldstein6, Michael Hier8, Khalil Sultanem9, Keith Richardson8, Alex Mlynarek8, Suren Krishnan10, Hien Le11, John Yoo1, S Danielle MacNeil1, Eric Winquist12, J Alex Hammond4, Varagur Venkatesan4, Sara Kuruvilla12, Andrew Warner4, Sylvia Mitchell4, Jeff Chen4, Martin Corsten13, Stephanie Johnson-Obaseki13, Michael Odell13, Christina Parker14, Bret Wehrli15, Keith Kwan15, David A Palma4. 1. Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada. 2. School of Communication Sciences and Disorders, Western University, London, Ontario, Canada. 3. Department of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada. 4. Department of Radiation Oncology, Western University, London, Ontario, Canada. 5. Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada. 6. Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. 7. Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada. 8. Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada. 9. Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada. 10. Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia. 11. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia. 12. Department of Medical Oncology, Western University, London, Ontario, Canada. 13. Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada. 14. Department of Audiology, London Health Sciences Centre, London, Ontario, Canada. 15. Department of Pathology, Western University, London, Ontario, Canada.
Abstract
PURPOSE: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has risen rapidly, because of an epidemic of human papillomavirus infection. The optimal management of early-stage OPSCC with surgery or radiation continues to be a clinical controversy. Long-term randomized data comparing these paradigms are lacking. METHODS: We randomly assigned patients with T1-T2, N0-2 (≤ 4 cm) OPSCC to radiotherapy (RT) (with chemotherapy if N1-2) versus transoral robotic surgery plus neck dissection (TORS + ND) (with or without adjuvant therapy). The primary end point was swallowing quality of life (QOL) at 1-year using the MD Anderson Dysphagia Inventory. Secondary end points included adverse events, other QOL outcomes, overall survival, and progression-free survival. All analyses were intention-to-treat. Herein, we present long-term outcomes from the trial. RESULTS: Sixty-eight patients were randomly assigned (n = 34 per arm) between August 10, 2012, and June 9, 2017. Median follow-up was 45 months. Longitudinal MD Anderson Dysphagia Inventory analyses demonstrated statistical superiority of RT arm over time (P = .049), although the differences beyond 1 year were of smaller magnitude than at the 1-year timepoint (year 2: 86.0 ± 13.5 in the RT arm v 84.8 ± 12.5 in the TORS + ND arm, P = .74; year 3: 88.9 ± 11.3 v 83.3 ± 13.9, P = .12). These differences did not meet the threshold to qualify as a clinically meaningful change at any timepoint. Certain differences in QOL concerns including more pain and dental concerns in the TORS + ND arm seen at 1 year resolved at 2 and 3 years; however, TORS patients started to use more nutritional supplements at 3 years (P = .015). Dry mouth scores were higher in RT patients over time (P = .041). CONCLUSION: On longitudinal analysis, the swallowing QOL difference between primary RT and TORS + ND approaches persists but decreases over time. Patients with OPSCC should be informed about the pros and cons of both treatment options (ClinicalTrials.gov identifier: NCT01590355).
PURPOSE: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has risen rapidly, because of an epidemic of human papillomavirus infection. The optimal management of early-stage OPSCC with surgery or radiation continues to be a clinical controversy. Long-term randomized data comparing these paradigms are lacking. METHODS: We randomly assigned patients with T1-T2, N0-2 (≤ 4 cm) OPSCC to radiotherapy (RT) (with chemotherapy if N1-2) versus transoral robotic surgery plus neck dissection (TORS + ND) (with or without adjuvant therapy). The primary end point was swallowing quality of life (QOL) at 1-year using the MD Anderson Dysphagia Inventory. Secondary end points included adverse events, other QOL outcomes, overall survival, and progression-free survival. All analyses were intention-to-treat. Herein, we present long-term outcomes from the trial. RESULTS: Sixty-eight patients were randomly assigned (n = 34 per arm) between August 10, 2012, and June 9, 2017. Median follow-up was 45 months. Longitudinal MD Anderson Dysphagia Inventory analyses demonstrated statistical superiority of RT arm over time (P = .049), although the differences beyond 1 year were of smaller magnitude than at the 1-year timepoint (year 2: 86.0 ± 13.5 in the RT arm v 84.8 ± 12.5 in the TORS + ND arm, P = .74; year 3: 88.9 ± 11.3 v 83.3 ± 13.9, P = .12). These differences did not meet the threshold to qualify as a clinically meaningful change at any timepoint. Certain differences in QOL concerns including more pain and dental concerns in the TORS + ND arm seen at 1 year resolved at 2 and 3 years; however, TORS patients started to use more nutritional supplements at 3 years (P = .015). Dry mouth scores were higher in RT patients over time (P = .041). CONCLUSION: On longitudinal analysis, the swallowing QOL difference between primary RT and TORS + ND approaches persists but decreases over time. Patients with OPSCC should be informed about the pros and cons of both treatment options (ClinicalTrials.gov identifier: NCT01590355).
Authors: Raymond L Chai; Rocco M Ferrandino; Christine Barron; Kianoush Donboli; Scott A Roof; Mohemmed N Khan; Marita S Teng; Marshall R Posner; Richard L Bakst; Eric M Genden Journal: Front Oncol Date: 2022-08-25 Impact factor: 5.738
Authors: Sebastian Zschaeck; Julian Weingärtner; Elia Lombardo; Sebastian Marschner; Marina Hajiyianni; Marcus Beck; Daniel Zips; Yimin Li; Qin Lin; Holger Amthauer; Esther G C Troost; Jörg van den Hoff; Volker Budach; Jörg Kotzerke; Konstantinos Ferentinos; Efstratios Karagiannis; David Kaul; Vincent Gregoire; Adrien Holzgreve; Nathalie L Albert; Pavel Nikulin; Michael Bachmann; Klaus Kopka; Mechthild Krause; Michael Baumann; Joanna Kazmierska; Paulina Cegla; Witold Cholewinski; Iosif Strouthos; Klaus Zöphel; Ewa Majchrzak; Guillaume Landry; Claus Belka; Carmen Stromberger; Frank Hofheinz Journal: Front Oncol Date: 2022-06-08 Impact factor: 5.738