2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

TABLE I. Patient Demographics.

TORS Alone

Adjuvant RT

Adjuvant CRT

P Value

Age, yr, mean (SD)

57.46 (9.38)

58.55 (7.74)

56.88 (7.93)

.64

Sex, no. (%)

.09

Male

8 (61.5%)

26 (83.9%)

58 (86.6%)

Female

5 (38.5%)

5 (16.1%)

9 (13.4%)

Smoking, no. (%)

.68

Never

2 (15.4%)

9 (29.0%)

19 (28.4%)

Current

4 (30.8%)

5 (16.1%)

10 (14.9%)

Former

7 (53.9%)

17 (54.8%)

38 (56.7%)

CRT 5 chemoradiation therapy; RT 5 radiation therapy; SD 5 standard deviation; TORS 5 transoral robotic surgery.

6 months, compared to those in the TORS alone and adjuvant RT groups. Of those who required a PEG tube, 38 (76%) were placed due to adjuvant CRT, with eight (16%) placed due to adjuvant RT, three (6%) due to a second surgery required for recurrence, and one (2%) due to an aspiration risk over 4 years post-treatment. Overall, none of the patients in all three groups required tracheostomy except two patients in the CRT group due to their local recurrence later at their follow-ups. Treatment group was not predictive of survival using Cox proportional hazards models. In comparing TORS alone, adjuvant RT, and adjuvant CRT, there were no significant differences in patients with locore- gional disease control (100.0% vs. 96.8% vs. 87.9%, P 5 .23), but TORS alone and adjuvant RT had a higher per- centage of distant disease control (100.0% vs. 100.0% vs. 86.4%, P 5 .05) based on a mean follow-up of 35 months (Table VI). Overall survival remained high in the TORS- alone group (100%). These data were obtained from the time of surgery to the last office visit and/or time of death, with one patient lost to follow-up. DISCUSSION TORS is emerging as a promising treatment option to avoid or decrease the deleterious side effects of RT and CRT and their negative effects on QOL in OPSCCA. There are few reports of using TORS alone in OPSCCA in the litera- ture. 8,16,17,20 To the best of our knowledge, the present study is the first to compare the long-term QOL outcomes of TORS alone and TORS with adjuvant therapy in OPSCCA. In the present study, patients who underwent TORS alone had continued improvement in QOL in mul- tiple domains shortly after surgery. These TORS-alone patients reported higher QOL scores in eating at 3 and 6 months postsurgery compared to adjuvant RT or CRT. TORS alone and adjuvant RT reported less social disrup- tion than adjuvant CRT at 3 months, and TORS alone had higher speech scores compared to adjuvant CRT at 3 months and adjuvant RT at 6 months. Adjuvant CRT had lower overall QOL scores compared to adjuvant RT or TORS alone at baseline and 3 months, adjuvant RT at 3 weeks, and TORS alone at 6 months. It was shown that adjuvant RT and CRT experienced more xerostomia and odynophagia, and adjuvant CRT had more oral

including doses completed, cycle, and dosages are also reported. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 80%, 60%, 55%, and 46%, respectively. QOL data are summarized in Figure 1. In overall QOL, patients who underwent adjuvant CRT had significantly lower scores than TORS alone and adjuvant RT at base- line (all P < .01) and 3 months ( P 5 .05 and P 5 .03, respectively). In addition, QOL scores for adjuvant CRT were significantly lower than for adjuvant RT (P 5 .01) at 3 weeks and for TORS alone ( P < .01) at 6 months. Eating domain and subdomain (functional and attitudi- nal) scores for TORS alone were significantly higher than for adjuvant RT and adjuvant CRT at 3 months (all P < .01) and 6 months (all P < .01, except for adjuvant RT in eating functional subdomain with P 5 .02) post- surgery. For the functional subdomain of social disrup- tion, patients who underwent adjuvant CRT had significantly lower scores (greater social disruption) when compared to TORS alone ( P < .01) and adjuvant RT ( P 5 .02) at 3 months. Speech (functional) scores for TORS alone were significantly higher than for adjuvant CRT at 3 months ( P 5 .04) and for adjuvant RT at 6 months ( P 5 .03) postsurgery. There were no statistically significant differences ( P > .05) in aesthetics, social dis- ruption (attitudinal), or speech (attitudinal) at any time point. Also, there were no statistically significant differ- ences ( P > .05) for all QOL domains at 12 months. Post-treatment side effects that are mostly related to adjuvant treatment are summarized in Table IV. Of note, the data were collected in a manner such that the variables reported could have occurred at any time point following surgery. However, weight loss during RT was obtained by analyzing the difference in weight immedi- ately before and after adjuvant RT. Table V summarizes functional outcomes following TORS and adjuvant treatments. Importantly, the data represent percutaneous endoscopic gastrostomy (PEG) or tracheostomy tube placement at any point from the time of surgery to the last known follow-up. PEG dependence at 3, 6, and 12 months postsurgery, as well as time to PEG placement and duration of dependence are also specified. None of the TORS-alone patients needed PEG or tracheostomy. The adjuvant CRT group experienced greater overall PEG tube dependence, including at 3 and

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Sethia et al.: QOL Outcomes of TORS for Oropharyngeal Cancer

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