Purpose
This study represents a subset analysis of quality of life outcomes among patients treated on a phase II trial of de-escalated chemoradiation for human papillomavirus (HPV)-associated oropharynx cancer.
Methods
Eligibility included newly-diagnosed, stage III or IV oropharyngeal squamous cell carcinoma, p16-positivity, age at least 18 years, and Zubrod performance status 0–1. Treatment was induction paclitaxel 175 mg/m2 and carboplatin AUC 6 for 2 cycles followed by response-adapted, dose-reduced radiation of 54 Gy or 60 Gy with weekly concurrent paclitaxel 30 mg/m2. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaires were used to assess patient-reported quality of life as a secondary endpoint.
Results
Forty-five patients were registered, of whom 40 completed quality of life surveys and were evaluable. Nadirs for overall UW-QOL and FACT-H&N scores were reached at 4 weeks after treatment but returned to baseline at 3 months. Nearly all functional indices returned to baseline levels by 6 to 9 months. The mean overall UW-QOL score was 71.6 at baseline compared to 70.8, 73.0, 83.3, and 81.1, at 3-months, 6-months, 1-year, and 2-years, respectively, post-therapy. The proportion rating their overall quality of life as “very good” or “outstanding” at 6-months, 1-year, and 2-years with the UW-QOL was 50%, 77%, and 84%, respectively.
Conclusion
This de-escalation regimen achieved quality of life outcomes that were favorable compared to historical controls. These results serve as powerful evidence that ongoing de-escalation efforts lead to tangible gains in function and quality of life.
This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R2) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R2 = 0.452; MAD = 0.0887; p = 1.17 × 10−3). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R2 = 0.932; MAD = 0.0283; p = 5.73 × 10−12). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate.
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