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Lee E, Magge H, Park I, Shakhtour L, Li N, Schottler J, Joshi AS, Thakkar PG, Goodman JF. Trends in Swallowing Outcomes Following Deintensified Treatment in Selected p16+ Oropharyngeal Carcinoma. OTO Open 2023; 7:e47. [PMID: 36998568 PMCID: PMC10046713 DOI: 10.1002/oto2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/28/2023] [Accepted: 02/25/2023] [Indexed: 03/30/2023] Open
Abstract
Objective Identify trends in swallowing outcomes in p16+ oropharyngeal squamous cell carcinoma following neoadjuvant chemotherapy+surgery (NAC+S) versus neoadjuvant chemotherapy+surgery+radiation (NAC+S+R). Study Design Cohort study. Setting Single academic institution. Methods Swallowing outcome was measured using a validated questionnaire, MD Anderson Dysphagia Inventory (MDADI). MDADI scores were compared between NAC+S and NAC+S+R groups in short-term (<1 year), middle-term (1-3 years), and long-term (>3 years). Clinical factors associated with MDADI scores were explored using a linear mixed model. Statistical significance was established at p < .05. Results Sixty-seven patients met the inclusion criteria and were divided into 2 groups: NAC+S (57 [85.1%]) and NAC+S+R (10 [14.9%]). All patients had improved MDADI scores in the middle-term compared to short-term (NAC+S: score increase = 3.43, p = .002; NAC+S+R: score increase = 11.18, p = .044), long-term compared to short-term (NAC+S: score increase = 6.97, p < .001; NAC+S+R: score increase = 20.35, p < .001), and long-term compared to middle-term (NAC+S: score increase = 3.54, p = .043; NAC+S+R: score increase = 9.18, p = .026). NAC+S patients had better MDADI scores than NAC+S+R patients at short-term (83.80 vs 71.26, p = .001). There was no significant difference in swallowing function in the middle-term or long-term. Conclusion Regardless of treatment type, swallowing will likely be improved in the middle-term and long-term compared to the short-term. Patients treated with NAC+S+R will have worse short-term swallowing function. However, in the middle-term and long-term, there is no significant difference in swallowing function between patients treated with NAC+S and NAC+S+R.
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Affiliation(s)
- Esther Lee
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Hari Magge
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Isabel Park
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Leyn Shakhtour
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Ning‐Wei Li
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Jennifer Schottler
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Arjun S. Joshi
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Punam G. Thakkar
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Joseph F. Goodman
- Division of Otolaryngology–Head and Neck SurgeryGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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O'Hara J, Warner L, Fox H, Hamilton D, Meikle D, Counter P, Robson A, Goranova R, Iqbal S, Kelly C, Robinson M, Paleri V. Primary transoral robotic surgery +/- adjuvant therapy for oropharyngeal squamous cell carcinoma-A large observational single-centre series from the United Kingdom. Clin Otolaryngol 2021; 46:1005-1012. [PMID: 33754476 DOI: 10.1111/coa.13769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/25/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). DESIGN Observational case series. SETTING Tertiary centre; first TORS practice to commence in the UK. PARTICIPANTS All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. MAIN OUTCOME MEASURES Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease-Specific, Progression-Free and Locoregional control. RESULTS The cohort comprised of 120 patients undergoing TORS with minimum 12-month follow-up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV-related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins <2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78-92), disease-specific 90% (85-96), progression-free 86% (79-92) and locoregional control 90% (84-96). The equivalent survival figures for the HPV-related cases alone were as follows: overall 88% (82-94), disease-specific 93% (87-98), progression-free 88% (81-95) and locoregional control 92% (87-98). CONCLUSIONS Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality.
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Affiliation(s)
- James O'Hara
- Consultant Otolaryngologist, The Freeman Hospital, Newcastle-upon-Tyne, UK.,Honorary Senior Clinical Lecturer, Newcastle University, UK
| | - Laura Warner
- Consultant Otolaryngologist, The Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Hannah Fox
- Consultant Otolaryngologist, The Freeman Hospital, Newcastle-upon-Tyne, UK
| | - David Hamilton
- Consultant Otolaryngologist, The Freeman Hospital, Newcastle-upon-Tyne, UK.,Honorary Senior Clinical Lecturer, Newcastle University, UK
| | - David Meikle
- Consultant Otolaryngologist, The Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Paul Counter
- Consultant Otolaryngologist, Cumberland Infirmary, Carlisle, UK
| | - Andrew Robson
- Consultant Otolaryngologist, Cumberland Infirmary, Carlisle, UK
| | - Rebecca Goranova
- Consultant Clinical Oncologist, University Hospitals, Plymouth, UK
| | - Shahid Iqbal
- Consultant Clinical Oncologist, The Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Charles Kelly
- Consultant Clinical Oncologist, The Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Max Robinson
- Consultant Cellular Pathologist, The Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Vinidh Paleri
- Consultant Otolaryngologist, The Royal Marsden Hospitals, London, UK
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Zuydam AC, Rogers SN, Grayson K, Probert CF. Routine Use of Swallowing Outcome Measures Following Head and Neck Cancer in a Multidisciplinary Clinic Setting. Int Arch Otorhinolaryngol 2020; 25:e185-e192. [PMID: 33968218 PMCID: PMC8096508 DOI: 10.1055/s-0040-1708896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Chemoradiotherapy treatment for head and neck cancer (HNC) can have a major impact on swallowing function and health-related quality of life.
The use of outcome measures in early detection of patients with swallowing problems provides the opportunity for targeting speech and language therapy (SLT) interventions to aid adaption and promote better clinical outcomes. Objective
The purpose of the present study was to assess relationships between four outcomes measures over time, in a cohort of HNC patients, treated by (chemo-)radiotherapy.
Methods
Data were collected at 3 months and 12 months, on 49 consecutive patients with primary squamous cell cancer of the oropharynx, nasopharynx or hypopharynx stage T1–4, N0–2b, M0 disease.
Results
Out of 49 eligible patients, 45 completed assessment at 3 months and 20 at 12 months. The 3-month outcomes gave a strong indication of performance at 1 year. There were several strong correlations found between measures. The strongest was between the 3-month Performance Status Scale for Head and Neck Cancer (PSSHN) and the 12-month PSSHN (rs = 0.761,
n
= 17), the 12-month PSSHN and the 12-month Functional Oral Intake Scale (FOIS) (rs = 0.823,
n
= 20), and the 12-month University of Washington Head and Neck Quality of Life (UWQoL) swallow and the 12-month Water Swallow Test (WST) capacity (rs = 0.759,
n
= 17).
Conclusion
The UW-QoL swallow item and WST are easy to incorporate into routine care and should be used as part of a standard assessment of swallow outcome. These measures can serve to help screen patients for dysfunction and focus allocation of resources for those who would benefit from more comprehensive assessment and intervention by SLT.
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Affiliation(s)
| | - Simon N Rogers
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom.,Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, United Kingdom
| | | | - Clare F Probert
- Shrewsbury and Telford NHS Trust, Shrewsbury, United Kingdom
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4
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Karsten RT, Brekel MW, Smeele LE, Navran A, Leary S, Ingarfield K, Pawlita M, Waterboer T, Thomas SJ, Ness AR. Patient‐reported swallowing function after treatment for early‐stage oropharyngeal carcinoma: Population‐based study. Head Neck 2020; 42:1981-1993. [DOI: 10.1002/hed.26131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Rebecca T. Karsten
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Michiel W.M. Brekel
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Ludi E. Smeele
- Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute Amsterdam The Netherlands
- Department of Oral and Maxillofacial SurgeryAcademic Medical Center Amsterdam The Netherlands
| | - Arash Navran
- Department of Radiation OncologyThe Netherlands Cancer Institute Amsterdam The Netherlands
| | - Sam Leary
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
| | - Kate Ingarfield
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
- Centre for Trials Research, College of Biomedical and Life SciencesCardiff University Cardiff UK
| | - Michael Pawlita
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Tim Waterboer
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Steve J. Thomas
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
| | - Andy R. Ness
- Bristol Biomedical Research Centre, National Institute of Health (NIHR)University of Bristol Bristol UK
- Bristol Dental SchoolFaculty of Health Sciences, University of Bristol Bristol UK
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5
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Ivy AJ, Stephen S, Goff D, Patterson J, Warner L, Paleri V, Goranova R, Kovarik J, Shaikh G, Kelly C, O’Hara J, Iqbal S, Meikle D. Long‐term swallowing outcomes following transoral surgery and adjuvant radiotherapy vs adjuvant chemoradiotherapy for oropharyngeal carcinoma: Our experience in 37 patients. Clin Otolaryngol 2019; 45:248-252. [DOI: 10.1111/coa.13416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/26/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022]
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6
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Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry. Oral Oncol 2019; 91:13-20. [DOI: 10.1016/j.oraloncology.2019.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
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7
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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 25:101-107. [PMID: 28106661 DOI: 10.1097/moo.0000000000000340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. RECENT FINDINGS Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. SUMMARY Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice.
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Fox H, Robson A, Cocks H, Meikle D, Kelly C, Goranova R, Kovarik J, Shaikh G, Paleri V, O'Hara J. Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection. Clin Otolaryngol 2017; 43:739-741. [DOI: 10.1111/coa.13040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - H. Cocks
- Sunderland Royal Hospital; Sunderland UK
| | | | - C. Kelly
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - R. Goranova
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - J. Kovarik
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - G. Shaikh
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
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9
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Research into the prevention and rehabilitation of dysphagia in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2016; 24:208-14. [DOI: 10.1097/moo.0000000000000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Rogers SN, Pinto RS, Lancaster J, Bekiroglu F, Lowe D, Tandon S, Jones TM. Health related quality of life following the treatment of oropharyngeal cancer by transoral laser. Eur Arch Otorhinolaryngol 2016; 273:3913-3920. [DOI: 10.1007/s00405-016-4035-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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11
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Dawe N, Patterson J, O'Hara J. Functional swallowing outcomes following treatment for oropharyngeal carcinoma: a systematic review of the evidence comparing trans-oral surgeryversusnon-surgical management. Clin Otolaryngol 2016; 41:371-85. [DOI: 10.1111/coa.12526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 01/22/2023]
Affiliation(s)
- N. Dawe
- Northern Deanery Otolaryngology Specialist Training; Newcastle upon Tyne UK
| | - J. Patterson
- Department of Speech and Language Therapy; City Hospitals Sunderland; Newcastle upon Tyne UK
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
| | - J. O'Hara
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
- Department of Otolaryngology - Head and Neck Surgery; The Freeman Hospital; Newcastle upon Tyne UK
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