Comparisons of dysphagia and quality of life (QOL) in comparable patients with HPV-positive oropharyngeal cancer receiving chemo-irradiation or cetuximab-irradiation

Abstract

Purpose Compare functional outcomes of radiotherapy (RT) concurrent with cetuximab (cet-RT) or with chemotherapy (chemo-RT) for comparable, good prognosis patients with Human Papillomavirus related (HPV+) oropharyngeal cancer (OPC). Methods Outcomes of patients with stage III/IV HPV+ OPC patients with minimal smoking history and non-T4/N3/N2C, treated on prospective protocol of RT concurrent with cetuximab (cet-RT), were compared to similar patients on prospective chemo-RT protocols. In both groups, videofluoroscopy (VF), observer rated dysphagia (ORD), and validated QOL questionnaires: Xerostomia Questionnaire (XQ), Head and Neck QOL, and University of Washington QOL, were performed periodically and compared to pretreatment. Mixed effects models with adjustment for baseline assessed differences between groups. Results 26 cet-RT patients were compared to 27 chemo-RT patients with similar baseline characteristics. In the chemo-RT group, no recurrences occurred. In the cet-RT group, 1 patient had persistent microscopic disease on salvage neck dissection and 1 distant failure. Both groups had mild VF-based swallowing dysfunction pre-treatment, worsened at 3 months (P<0.02) and persisted at 12 months, not differing between groups (P>0.11). For both groups ORD was very low pretreatment, worsened at 3 months and improved at 12 months, without differences between treatment groups (P=0.26). QOL Summary and domain scores for eating were good pretreatment, worse at 3 mo, and then improved to near baseline at 12 months, without differences between the groups in any QOL domains (P>0.10). Conclusion Both groups had excellent clinical outcomes without significant differences in objective or subjective functions. These data question using cetuximab instead of chemotherapy for treatment de-intensification for HPV+ OPC.

Helical intensity‐modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns

“…[31][32][33] However, there are limited prospective studies directly comparing outcomes for the 2 techniques to allow definitive conclusions at this time. 6,7,10,14,15,45,[48][49][50] Overall, results indicate there is a pattern of improved outcomes in the current study, with the exception of dysphagia and xerostomia. Similarly, Chen et al 47 found no statistical difference in acute mucositis, dysphagia, and xerostomia rates between helical tomotherapy IMRT and a step-and-shoot IMRT in a study of 149 patients with mixed tumor sites.…”

“…Although limited, direct comparison of the current results with key selected literature for patients with oropharyngeal SCC and oropharyngeal cancer undergoing traditional IMRT with concurrent chemotherapy, can also be seen in Table 4. 6,7,10,14,15,45,[48][49][50] Overall, results indicate there is a pattern of improved outcomes in the current study, with the exception of dysphagia and xerostomia. The rates of acute grade 3 mucositis found in the current study are similar or lower than those reported in the traditional IMRT literature.…”

“…Unfortunately, there is limited discussion of this in the head and neck cancer literature, with only 1 study examining outcomes for patients with oropharyngeal SCC reporting this information. 14 Samuels et al 14 found physician-reported mucositis rates started low, rose in weeks 3 to 4, peaked in weeks 5 to 7, and generally improved by 4 weeks posttreatment. Similarly, we found an onset of symptoms requiring supportive care from weeks 2 to 3 of treatment, with a dramatic increase in incidence from weeks 3 to 4 and a peak in week 7 (see Figure 1).…”

“…6,[8][9][10][11][12] Grade 3 mucositis during CRT for oropharyngeal SCC is common, with incidence rates ranging from 21%-80% reported in the literature. 6,7,10,[13][14][15] Oropharyngeal dysphagia is of particular concern for this patient group, 16,17 with aspiration pneumonia an underreported consequence of CRT for oropharyngeal SCC. 18,19 Oropharyngeal tumors are associated with greater difficulty in managing semisolid diets, 20 with one-third to two-thirds of patients experiencing grade 3 dysphagia requiring enteral nutrition support when undergoing CRT using intensity-modulated radiotherapy (IMRT).…”

“…2 Currently, chemoradiotherapy (CRT) is considered the standard of care for locally advanced oropharyngeal SCC, 3,4 offering 5-year survival rates of 74% for HPV-positive disease 5 with the benefit of organ function preservation. 6,7,10,[13][14][15] Oropharyngeal dysphagia is of particular concern for this patient group, 16,17 with aspiration pneumonia an underreported consequence of CRT for oropharyngeal SCC. 6,7 Within this population, pain, mucositis, dysphagia, dysgeusia, xerostomia, thick saliva, nausea, fatigue, and dermatitis are frequently reported during treatment, whereas xerostomia, dysphagia, fibrosis, and pain can become chronic issues known to negatively influence quality of life (QOL).…”