Patient-reported quality of life and toxicity in unilateral and bilateral radiotherapy for early-stage human papillomavirus associated tonsillar carcinoma

Abstract

a b s t r a c tPurpose: The purpose of this study was to compare self-reported health-related quality of life (QoL) and symptom burden in early stage tonsillar carcinoma patients treated with unilateral (URT) and bilateral radiotherapy (BRT). Methods and materials: This is a secondary analysis of a larger study assessing patient reported outcomes in human papillomavirus (HPV) oropharyngeal cancer (OPC) patients. Recruited patients were !12 months from completion of radiotherapy. This analysis included only patients with T1-2, N1-2b tonsil cancer and excluded patients with base of tongue involvement or recurrent disease. QoL and patient reported toxicity was measured using the EORTC QLQ-C30 module and the MDASI-HN. Results: Patients were enrolled from November 2018 to May 2019. Of the 136 patients recruited to the main study, 43 were eligible for this substudy (22 URT, 21 BRT), with a median age and follow up of 58.2 and 3.0 years respectively. The two groups were balanced with respect to patient, tumor and treatment factors with the exception of higher rates of T2 disease (27% v 71%, p = 0.006) and more extensive GTV nodal volumes (11.0 v 25.5cc, p = 0.006) in the BRT group.BRT patients had lower global health status/QoL (84 v 69, p = 0.0005) and social functioning scores (93 vs 78, p = 0.033) on the EORTC QLQ-C30, and higher symptom severity (0.6 vs. 2.0, p = 0.001) and symptom interference scores (0.8 vs. 2.0, p = 0.010) on the MDASI-HN. Four of the six largest differences observed on MDASI-HN items were attributable to radiotherapy technique (dry mouth, mucous, difficulty swallowing/chewing and taste), with corresponding dose differences to the respective organs (contralateral parotid, oral cavity and pharyngeal constrictors). In every instance, severity of symptoms was worse on average for patients treated with BRT. Conclusions: In the highly conformal radiotherapy era, BRT in early HPV tonsillar cancer survivors has an enduring impact on long-term QoL and toxicity. Crown

Patient- and Clinician-Reported Outcomes in Human Papillomavirus-Associated Tonsillar Carcinoma Treated With Unilateral and Bilateral Intensity Modulated Radiation Therapy–A Substudy From TROG 12.01

“…In contrast to our findings, a contemporary report from the Peter MacCallum Cancer Centre found large and clinically relevant differences across a number of PRO domains with fewer patients (URT 22, BRT 21) than included in this report. 36 In that cross-sectional report (mean follow-up 3.2 years) of stage-matched patients with tonsillar carcinoma (also T1-2, N1-2b), clinically significant differences were observed in the mean symptom severity (0.6 vs 2.0, P = .001) and symptom interference (0.8 vs 2.0, P = .01) scores of the MDASI-HN, and HRQL as assessed by the EORTC QLQ-C30 global health score (84 vs 69, P = .005). 36 Much larger differences were also seen on multiple single MDASI-HN symptom items reported in that study.…”

“…36 In that cross-sectional report (mean follow-up 3.2 years) of stage-matched patients with tonsillar carcinoma (also T1-2, N1-2b), clinically significant differences were observed in the mean symptom severity (0.6 vs 2.0, P = .001) and symptom interference (0.8 vs 2.0, P = .01) scores of the MDASI-HN, and HRQL as assessed by the EORTC QLQ-C30 global health score (84 vs 69, P = .005). 36 Much larger differences were also seen on multiple single MDASI-HN symptom items reported in that study. Abbreviations: CTCAE = national cancer institute common terminology criteria for adverse events, G1 = grade 1, G2 = grade 2.…”

Synchronous tonsillar tumors with differing histopathology: A case report and review of the literature

“… 20 Additionally, bilateral radiation therapy was associated with poorer quality of life and increased toxicity complications. 21 Unilateral radiation therapy can be best considered for patients with a low risk of contralateral neck failure.…”

“…Bilateral radiation therapy for HPV+ tonsillar cancer may result in significantly higher healthcare resource utilization as compared to unilateral radiation therapy and should only be considered if there is a strong medical indication 20 . Additionally, bilateral radiation therapy was associated with poorer quality of life and increased toxicity complications 21 . Unilateral radiation therapy can be best considered for patients with a low risk of contralateral neck failure.…”

Characterizing Lymph Node Burden With Elective Unilateral Neck Irradiation in Human Papillomavirus-Positive Tonsil Squamous Cell Carcinoma: Defining the Upper Limits

“…With the improvement in technical capabilities provided by intensity-modulated radiation therapy (IMRT), clinicians began exploring reduced treatment volumes in well-selected patients. Prior prospectively collected data have demonstrated improved quality of life [4] and reduced feeding tube rates [5], with a reduction in elective nodal irradiation volumes [6].…”