TY - JOUR
T1 - Swallowing After Primary TORS and Unilateral or Bilateral Radiation for Low- to Intermediate-Risk Tonsil Cancer
AU - Barbon, Carly E.A.
AU - Yao, Christopher M.K.
AU - Peterson, Christine B.
AU - Moreno, Amy C.
AU - Goepfert, Ryan P.
AU - Johnson, Faye M.
AU - Chronowski, Gregory M.
AU - Fuller, Clifton D.
AU - Gross, Neil D.
AU - Hutcheson, Katherine A.
N1 - Funding Information:
Funding source: This work was directly supported by the Charles and Daneen Stiefel Oropharynx Fund. Christine B. Peterson was partially supported by the National Institutes of Health/National Cancer Institute (Cancer Center Support Grant P30 CA016672; Biostatistics Resource Group).
Funding Information:
Competing interests : Katherine A. Hutcheson—research grants and contracts from the National Institutes of Health and the Patient-Centered Outcomes Research Institute outside the submitted work and personal fees from Medbridge, the American Speech-Language Hearing Association, and Atos Medical. Clifton D. Fuller—grants and personal fees from the National Institutes of Health and Elekta AB and personal fees from the Greater Baltimore Medical Center, Tianjin Memorial Hospital, and American Association of Physicists in Medicine outside the submitted work. Neil D. Gross—personal fees from Intuitive Surgical, Sanofi Genzyme, Regeneron, and Shattuck Labs and nonfinancial support from Regeneron outside the submitted work.
Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021.
PY - 2022/9
Y1 - 2022/9
N2 - Objective: The primary course of treatment for patients with low- to intermediate-risk tonsil cancer has evolved with a shift toward primary transoral robotic surgery (TORS) or radiation therapy (RT). While favorable outcomes have been reported after deintensification via unilateral TORS or RT (uniRT), comparisons of functional outcomes between these treatments are lacking. We compared clinical outcomes (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST] and feeding tube [FT]) and patient-reported swallowing outcomes (MD Anderson Dysphagia Inventory [MDADI]) based on primary treatment strategy: TORS, uniRT, or bilateral RT (biRT). Study Design: Secondary analysis of prospective cohort. Setting: Single institution. Methods: The study sample comprised 135 patients with HPV/p16+ T1-T3, N0-2b (American Joint Committee on Cancer, seventh edition), N0-1 (eighth edition) squamous cell carcinoma of the tonsil were sampled from a prospective registry. Modified barium swallow studies graded per DIGEST, FT placement and duration, and MDADI were collected. Results: Baseline DIGEST grade significantly differed among treatment groups, with higher dysphagia prevalence in the TORS group (34%) vs the biRT group (12%, P =.04). No significant group differences were found in DIGEST grade or dysphagia prevalence at subacute and longitudinal time points (P =.41). Mean MDADI scores were similar among groups at baseline (TORS, 92; uniRT, 93; biRT, 93; P =.90), subacute (TORS, 83; uniRT, 88; biRT, 82; P =.38) and late time points (TORS, 86; uniRT, 86; biRT, 87; P =.99). FT placement and duration significantly differed among primary treatment groups (FT [median days]: TORS, 89% [3]; uniRT, 8% [82]; biRT, 37% [104]; P <.001). Conclusion: While TORS and uniRT offer optimal functional outcomes related to dysphagia, results suggest that no measurable clinician-graded or patient-reported differences in swallow outcomes exist among these primary treatment strategies and biRT. Aside from baseline differences that drive treatment selection, differences in FT rate and duration by primary treatment strategy likely reflect diverse toxicities beyond dysphagia.
AB - Objective: The primary course of treatment for patients with low- to intermediate-risk tonsil cancer has evolved with a shift toward primary transoral robotic surgery (TORS) or radiation therapy (RT). While favorable outcomes have been reported after deintensification via unilateral TORS or RT (uniRT), comparisons of functional outcomes between these treatments are lacking. We compared clinical outcomes (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST] and feeding tube [FT]) and patient-reported swallowing outcomes (MD Anderson Dysphagia Inventory [MDADI]) based on primary treatment strategy: TORS, uniRT, or bilateral RT (biRT). Study Design: Secondary analysis of prospective cohort. Setting: Single institution. Methods: The study sample comprised 135 patients with HPV/p16+ T1-T3, N0-2b (American Joint Committee on Cancer, seventh edition), N0-1 (eighth edition) squamous cell carcinoma of the tonsil were sampled from a prospective registry. Modified barium swallow studies graded per DIGEST, FT placement and duration, and MDADI were collected. Results: Baseline DIGEST grade significantly differed among treatment groups, with higher dysphagia prevalence in the TORS group (34%) vs the biRT group (12%, P =.04). No significant group differences were found in DIGEST grade or dysphagia prevalence at subacute and longitudinal time points (P =.41). Mean MDADI scores were similar among groups at baseline (TORS, 92; uniRT, 93; biRT, 93; P =.90), subacute (TORS, 83; uniRT, 88; biRT, 82; P =.38) and late time points (TORS, 86; uniRT, 86; biRT, 87; P =.99). FT placement and duration significantly differed among primary treatment groups (FT [median days]: TORS, 89% [3]; uniRT, 8% [82]; biRT, 37% [104]; P <.001). Conclusion: While TORS and uniRT offer optimal functional outcomes related to dysphagia, results suggest that no measurable clinician-graded or patient-reported differences in swallow outcomes exist among these primary treatment strategies and biRT. Aside from baseline differences that drive treatment selection, differences in FT rate and duration by primary treatment strategy likely reflect diverse toxicities beyond dysphagia.
KW - dysphagia
KW - head and neck cancer
KW - radiation
KW - surgery
KW - unilateral
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U2 - 10.1177/01945998211059967
DO - 10.1177/01945998211059967
M3 - Article
C2 - 34784256
AN - SCOPUS:85119122184
SN - 0194-5998
VL - 167
SP - 484
EP - 493
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 3
ER -