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

TABLE III. Adjuvant Treatment Details.

Adjuvant RT

Adjuvant CRT

P Value

RT

Duration, d

44 (42–47)

45 (43–54)

.21 .15

Dose, cGy

6,320 (6,000–6,600)

6,600 (6,000–6,600)

Fractions

33 (30–33)

33 (30–34)

.14

CRT

Doses completed

5 (3–7)

Cycle, d

7 (7–21)

Carboplatin dosage, mg

185 (75–260)

Cisplatin dosage, mg

77 (59–179)

Cetuximab dosage, mg

532 (392–552)

Data are reported as median (interquartile range: 25th percentile–75th percentile). CRT 5 chemoradiation therapy; RT 5 radiation therapy.

similar patient population, the mean follow-up was 14 months, and only outcomes for TORS alone were reported. The current study had a longer follow-up of 35 months and presented a comparison between TORS alone and adjuvant therapy. Furthermore, this study also includes a unique analysis of adjuvant RT and adjuvant CRT sepa- rately, which revealed that patients with adjuvant CRT experience more significant declines in QOL than patients with adjuvant RT. To avoid the combined toxicity and related decrease in QOL of triple modality regimens, patient selection for TORS should be aimed toward patients with early-stage diseases who are unlikely to need adjuvant treatment, especially chemoradiation. In comparing overall survival, the adjuvant CRT group would be expected to have the lowest survival compared to the adjuvant RT and TORS alone groups, because the adjuvant CRT group had higher proportions of N2/N3 patients, ECS, and positive lymph nodes than the other groups (Table II). The main limitation of this study was the small sample size of the TORS-alone group. In addition, due to the far-reaching patient popu- lation of those served at The Ohio State University Wex- ner Medical Center, some patients underwent adjuvant treatment at different medical centers closer to their area of residence. This contributed a challenge to stan- dardization of adjuvant treatment in those patients. Although it is anticipated for a long-term study, dimin- ished response rates for the HNCI survey at 6 and 12 months might have increased risk of selection bias. A multivariate analysis adjusting for demographic, pathologic, and clinical factors on QOL was not incorpo- rated into this study, as the aim was to provide an over- view comparison between treatment groups using exploratory analyses. However, our findings combined with those of recent reports suggest a need for further investigation of the effect of adjuvant RT/CRT on clini- cal, functional, and QOL outcomes of TORS patients. Moreover, studying QOL outcomes beyond 12 months could further enhance assessment of these patients. The ultimate goal of this study was to compare the long-term QOL of TORS alone, adjuvant RT, and CRT for oropharyngeal cancer patients. Adjuvant RT and

Clearly, side effects of adjuvant therapy such as xerostomia, odynophagia, and oral thrush play an impor- tant role in the lower QOL scores in the eating domain among adjuvant therapy patients. Overall, the results presented substantiate findings of recent studies that reported superior QOL outcomes in patients who under- went TORS alone 8,16 and decreased QOL with adjuvant therapy 1,6 with comparable clinical outcomes. 17 A number of studies from the Head and Neck Research Group at The Ohio State University have described negative effects of adjuvant therapy in TORS patients. In 2013, it was reported that QOL declined in the early postoperative period but remained high at 12 months. Notably, adjuvant treatment and RT were shown to decrease QOL. 6 In a similar study, lower post- operative scores in eating, social, and overall QOL domains for patients who underwent adjuvant RT were reported. 3 Furthermore, TORS patients with previously intact swallowing have been shown to require gastro- stomy tube placement during adjuvant RT, suggesting a detrimental influence on patient function. 21,22 In all of these studies, adjuvant RT is consistently associated with higher morbidity and decreased long-term QOL. The current study further examines the effect of this adjuvant therapy by comparing clinical, functional, and QOL outcomes between treatment groups and specifi- cally differentiating adjuvant RT patients from adjuvant CRT patients. The results from this study substantiate the find- ings of recent studies that have examined QOL outcomes of patients who underwent TORS alone. In a 2015 study of patients with base of tongue tumors, objective swal- lowing function in patients treated with TORS alone deteriorated in the first 6 months, but recovered after 1 year. Importantly, these patients experienced preserva- tion of self-perceived swallowing function, voice function, and related QOL up to 12 months postsurgery. 16 A similar QOL analysis was also published by Choby et al. The authors found that patients with oro- pharyngeal cancer treated with TORS alone reported significant improvement in chewing, swallowing, pain, and activity. 8 Although this study examined QOL in a

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

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