Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy

Abstract

Background and purposeTo compare early (3 and 6 month) and later (12 and 24 month) functional outcomes of stage III and IV (M0) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal (3DCRT) or intensity modulated radiotherapy (IMRT).Patients and methods200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospectively assessed at pre-treatment and 3, 6, 12 and 24 months post treatment. A standard functional outcomes protocol including performance status (KPS, ECOG), 3 Performance Status scales for Head and Neck (PSS-HN), the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), Voice Handicap Index-10 (VHI-10) and self-rated xerostomia were applied.ResultsMean age at diagnosis was 59 years. The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients. Median follow up was 2.5 years for the second cohort. Concomitant therapy was used in 159 (79.5%). Overall survival at 3 years was 75.6% and 71.5% for IMRT and 3DCRT cohorts respectively (not significant). A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias. KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment. The 3 PSS-HN scales, Eating in Public (p < 0.001), Understandability of Speech (p = 0.009) and Oral Diet Texture (p = 0.002) and all showed significantly better outcomes in favor of IMRT. The RBHOMS showed a difference in favor of IMRT which appeared during 3 to 6 months (p < 0.001). The VHI-10 also showed a difference in favor of IMRT (p = 0.015). Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005ConclusionsA prospectively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early (3–6 months) and later (12–24 months) in the treatment of oropharyngeal carcinoma with equivalent survival. These data support the adoption of IMRT as the standard radiation treatment method for patients with stage III and IV (M0) oropharyngeal squamous carcinoma. KPS and ECOG may not be sensitive to oropharyngeal cancer patients’ functional outcomes by treatment.

Functional Swallowing Units (FSUs) as organs-at-risk for radiotherapy. PART 1: Physiology and anatomy

“…Aspiration, quite often of a silent nature, yields a high risk of potentially life threatening aspiration pneumonia [4][5][6][7][8][9][10]. Considering the clinical and social relevance of swallowing problems, many radiation oncologists introduced swallowing sparing strategies, using Intensity Modulated Radiation Therapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) [11][12][13]. To preserve swallowing function and increase consistency of published results, a consensus on the definition of swallowing organs at risk (SWOARs) has been established [14,15].…”

Swallowing outcomes for patients with oropharyngeal squamous cell carcinoma treated with primary (chemo)radiation therapy receiving either prophylactic gastrostomy or reactive nasogastric tube: A prospective cohort study

“…The introduction of intensity‐modulated radiotherapy (IMRT) was hoped to reduce the effects on swallowing. Emerging evidence suggests lower rates of gastrostomy dependency and improved swallowing outcomes compared to patients treated with 3D conformal radiotherapy …”

“…Emerging evidence suggests lower rates of gastrostomy dependency and improved swallowing outcomes compared to patients treated with 3D conformal radiotherapy. [12][13][14] The aim of this study was to investigate swallowing outcomes for OPSCC patients treated with CRT receiving prophylactic gastrostomy, rNGT or no tube, in the absence of pre-treatment dysphagia.…”

Human papillomavirus–associated oropharyngeal squamous cell carcinoma and anogenital cancers in men: Epidemiologic evaluation of association

“…Other oncogenic HPVs are rarely detected in head and neck cancers . Molecular and epidemiologic studies suggest that HPV‐positive OPSCC comprise a distinct disease entity, which has a better prognosis . Immunohistochemistry using p16 has been used as a surrogate marker of oncogenic HPV and is now widely accepted …”

“…6,10 Molecular and epidemiologic studies suggest that HPV-positive OPSCC comprise a distinct disease entity, which has a better prognosis. 3,4,9,[11][12][13][14][15][16][17][18][19][20][21][22][23] Immunohistochemistry using p16 has been used as a surrogate marker of oncogenic HPV and is now widely accepted. 24 Currently, HPV-related cancers are one of the most important topics discussed in oncology, as HPV is a wellestablished etiological factor in carcinomas of the cervix, vulva, anus, and penis.…”