Comparison of functional outcomes and quality of life between transoral surgery and definitive chemoradiotherapy for oropharyngeal cancer

Chen, Allen M.; Daly, Megan E.; Luu, Quang; Donald, Paul J.; Farwell, D. Gregory

doi:10.1002/hed.23610

Cited by 88 publications

(105 citation statements)

References 20 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…Notably, 74% of patients treated with primary transoral surgery reported swallowing “as well as ever” at 1-year compared with only 32% of patients in the chemoradiation group. 35 Findings from both of these case-control studies favor better long-term swallowing recovery with upfront transoral surgery (robotic or laser) and adjuvant radiation at postoperative doses. Nevertheless, retrospective and historical comparisons do not adequately account for confounding factors that influence functional outcomes.…”

Section: Discussionmentioning

confidence: 96%

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

198

191

View full text Add to dashboard Cite

OBJECTIVE Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). STUDY DESIGN A systematic review was conducted. The MEDLINE database was searched (MeSH terms: transoral robotic surgery, pharyngeal neoplasms, oropharyngeal neoplasms). METHODS Peer-reviewed human subject papers published through December, 2013 were included. Exclusion criteria were: 1) case report design (n<10), 2) review article, or 3) technical, animal or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. RESULTS Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18% to 39% of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0% to 7% (mean follow-up: 11–26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up: 12–13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0% to 7%. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4% to 9%. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6- and 12-months. CONCLUSIONS Crude endpoints of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.

show abstract

Section: Discussionmentioning

confidence: 96%

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

198

191

View full text Add to dashboard Cite

show abstract

“…Some patients may experience changes in how they taste food or lose their sense of taste altogether. Still others may experience hoarseness or other voice changes that may be permanent [22]. Patients who undergo chemotherapy may experience side effects such as mucositis (severe mouth ulcers), hearing loss, nausea and vomiting, diarrhea, weakness, and fatigue [23].…”

Section: How Common Is Hpv Positive Head and Neck Cancer?mentioning

confidence: 99%

Increase in head and neck cancer in younger patients due to human papillomavirus (HPV)

et al. 2015

View full text Add to dashboard Cite

“…11–13 Studies 13,14 have compared unmatched patients with OPSCC undergoing TORS and nonsurgical therapy with results suggesting better swallowing-related outcomes in patients undergoing TORS. A study examining QOL among patients with OPSCC matched on 10 factors (including age, sex, tumor stage, and tumor human papillomavirus [HPV] status) showed that patients who had undergone transoral surgery, such as TORS, had significantly higher scores in the swallowing domain at 1 year after treatment in univariable analysis (multivariable models were not generated in the study).…”

mentioning

confidence: 99%

“…A study examining QOL among patients with OPSCC matched on 10 factors (including age, sex, tumor stage, and tumor human papillomavirus [HPV] status) showed that patients who had undergone transoral surgery, such as TORS, had significantly higher scores in the swallowing domain at 1 year after treatment in univariable analysis (multivariable models were not generated in the study). 11 …”

mentioning

confidence: 99%

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Sharma

Patel

Baik

et al. 2016

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCE Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited. OBJECTIVE To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015. MAIN OUTCOMES AND MEASURES Disease-free survival, overall survival, and gastrostomy tube prevalence. RESULTS One hundred twenty-seven patients met the study criteria (113 men [89.0%];14 women [11.0%]; median [interquartile range] age, 57 [52–63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04–1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27–0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27–0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group:3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at3 months to 7 of 66 [11%] at 12 months). CONCLUSIONS AND RELEVANCE Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.

show abstract

Comparison of functional outcomes and quality of life between transoral surgery and definitive chemoradiotherapy for oropharyngeal cancer

Abstract: Similar quality of life was observed among patients treated by transoral surgery or chemoradiotherapy. Although the rates of subjective swallowing dysfunction were higher among the latter, confounding biases must be considered.

Cited by 88 publications

References 20 publications

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Increase in head and neck cancer in younger patients due to human papillomavirus (HPV)

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Contact Info

Product

Resources

About