Functional Swallowing Outcomes Following Transoral Robotic Surgery vs Primary Chemoradiotherapy in Patients With Advanced-Stage Oropharynx and Supraglottis Cancers

More, Yogesh; Tsue, Terance T.; Girod, Douglas A.; Harbison, John W.; Sykes, Kevin J.; Williams, C; Shnayder, Yelizaveta

doi:10.1001/jamaoto.2013.1074

Cited by 138 publications

(115 citation statements)

References 18 publications

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“…All were single-institution case series (level 4 evidence). Three studies reported on TORS for advanced (III–IV), 11,14,17 nd one reported outcomes for early (T1–T2) OPC tumors. 10 The remaining 8 studies reported outcomes after TORS for all stages of disease (AJCC I–IV).…”

Section: Resultsmentioning

confidence: 99%

“…Rates of perioperative feeding tube placement varied widely by disease stage and institutional practices (3% to 100%), and the average duration of perioperative nasogastric tubes was 2 to 13 days. 11,13,17,18 Excluding prophylactic placement, 15 18% to 39% of patients required gastrostomy placement, typically during adjuvant therapy. A single study of radical tonsillectomy reported the placement of gastrostomy tubes intraoperatively in all patients.…”

Section: Resultsmentioning

confidence: 99%

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Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

189

179

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Hutcheson

Holsinger

Kupferman

et al. 2014

Eur Arch Otorhinolaryngol

189

179

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“…Our study population mainly consisted of HNC patients with stage IV diseases (.80%) who went through concurrent CRT with high-dose radiation (70 Gy), thus representing a very advanced HNC population. Recent studies suggest that this population of HNC patients do not exhibit significant improvement in MDADI scores at 12 months after CRT [14,15,22,23]. This contrasts with longer-term observations of less advanced patients, among whom improvements have been reported after 22 months [12].…”

Section: Discussionmentioning

confidence: 95%

“…It has been used in a number of prior studies [12][13][14] and characterizes how patients view their swallowing ability as a result of treatment and how the swallowing dysfunction affects their QOL. The MDADI has been used to track the longitudinal course of individual patient's outcomes [14,15]. The MDADI has four subscales--global, emotional, physical, and functional--to characterize the effects of dysphagia on different aspects of QOL.…”

Section: Outcome Measuresmentioning

confidence: 99%

Acupuncture for Chemoradiation Therapy-Related Dysphagia in Head and Neck Cancer: A Pilot Randomized Sham-Controlled Trial

Wayne

Davis

et al. 2016

The Oncologist

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Introduction. Dysphagia is common in head and neck cancer patients after concurrent chemoradiation therapy (CRT). This study evaluated the feasibility of conducting a randomized sham-controlled trial and collected preliminary data on safety and efficacy of acupuncture. Patients and Methods. Head and neck cancer (HNC) patients with stage III-IV squamous cell carcinoma were randomized to 12 sessions of either active acupuncture (AA) or sham acupuncture (SA) during and following CRT. Patients were blinded to treatment assignment. Swallowing-related quality of life (QOL) was assessed using the MD Anderson Dysphagia Inventory (MDADI) total and subscale scores. Results. Multiple aspects of trial feasibility were confirmed. Forty-two of 196 patients screened (21%) were enrolled and randomized to receive AA (n 5 21) or SA (n 5 21); 79% completed at least 10 of 12 planned acupuncture sessions; 81%

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“…This score compared favorably with reports in the literature evaluating the MDADI in OPSCC patients treated with CRT [39]. A prospective non-randomized trial by More et al [40] compared the MDADI between patients with advanced stage OPSCC and supraglottic cancers following either TORS or CRT and found that there was no difference in the mean MDADI scores between the groups 3 months post-treatment, but that there was a difference at 6 months and 1 year. The TORS group had a significantly better mean MDADI score at 6 months and returned to baseline (78) at 1 year, whereas the CRT group fell from a baseline of 78 but only recovered to a mean score of 60.…”

Section: Functional Outcomesmentioning

confidence: 55%

The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Squamous Cell Carcinoma: a Current Review

Sansoni

Gross

2015

Curr Oncol Rep

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The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing in the USA despite a decline in traditional risk factors. This trend is attributed to human papillomavirus (HPV)-associated malignancies and is particularly notable in a younger patient demographic with fewer comorbid diseases and longer life expectancies. Therefore, both oncologic and functional outcomes are important to consider when managing OPSCC in the modern era. The historical management of OPSCC was typically surgical, but traditional open approaches resulted in significant morbidity. As the paradigm shifted, organ-preserving treatment regimens, namely, radiotherapy (RT) and chemoradiation (CRT), replaced surgery as the primary treatment modality. However, these treatment strategies are not without risk of significant sequelae and functional impairment. Transoral robotic surgery (TORS) is a minimally invasive surgical approach that offers surgical access to the oropharynx without the morbidity of open procedures while achieving excellent oncologic and functional outcomes. The appropriate application of this new technology is still being investigated but the current literature supports TORS as a viable option in the management of OPSCC.

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Functional Swallowing Outcomes Following Transoral Robotic Surgery vs Primary Chemoradiotherapy in Patients With Advanced-Stage Oropharynx and Supraglottis Cancers

Abstract: Advanced-stage oropharynx and supraglottis cancers managed by transoral robotic surgery with adjuvant therapy resulted in significantly better swallowing MDADI outcomes at the follow-up visits at 6 and 12 months compared with tumors treated by primary chemoradiotherapy.

Cited by 138 publications

References 18 publications

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Functional outcomes after TORS for oropharyngeal cancer: a systematic review

Acupuncture for Chemoradiation Therapy-Related Dysphagia in Head and Neck Cancer: A Pilot Randomized Sham-Controlled Trial

The Role of Transoral Robotic Surgery in the Management of Oropharyngeal Squamous Cell Carcinoma: a Current Review

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