Swallowing Function Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharyngeal Carcinoma: A 2-Year Follow-up. (August 2022)

• Record Type: Journal Article
• Authors: Lee, Esther; Gorelik, Daniel; Crowder, Hannah R.; Badger, Christopher; Schottler, Jennifer; Li, Ning-Wei; Siegel, Robert; Sadeghi, Nader; Goodman, Joseph F.; Thakkar, Punam G.; Joshi, Arjun S.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 167:Number 2(2022)
• Page Start: 298
• Page End: 304
• Publication Date: 2022-08
• Subjects: oropharyngeal squamous cell carcinoma -- neoadjuvant chemotherapy -- transoral robotic surgery -- swallowing -- MD Anderson Dysphagia Inventory (MDADI); Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998211057430
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: To evaluate 2-year follow-up swallowing function in patients with human papillomavirus–related oropharyngeal squamous cell carcinoma (HPV+ OPSCC) who completed neoadjuvant chemotherapy and transoral robotic surgery (NAC+S) Study Design: Retrospective analysis of patients with OPSCC treated with NAC+S between 2010 and 2021. Setting: A single academic institution. Methods: This is a cross-sectional study of patient-reported swallowing function, assessed with the MD Anderson Dysphagia Inventory (MDADI) at least 2 years after completion of treatment. The inclusion criteria are patients with HPV+ OPSCC who underwent NAC+S at least 2 years ago. Those requiring adjuvant radiation or chemoradiation or experiencing relapse were excluded from the study. Results: Completed MDADIs were received from 37 patients at a median 3.8 years posttreatment (interquartile range, 2.0-8.6 years). Of those, 94.6% (n = 35) were male and 81.1% (n = 30) were White. The median age at OPSCC diagnosis was 59.0 years (interquartile range, 41-80 years). The most frequent primary subsite of OPSCC was the base of the tongue (n = 20, 54.1%), followed by the tonsils (n = 16, 43.2%). In addition, 75.7% (n = 28) had stage IVa disease (TNM seventh edition), and 29 (78.4%) had scores ≥80, classified as optimal function. When compared with patients who received bilateral neck dissection, patients who received unilateral neck dissection were associated with an age <65 years old ( P = .036) and lower clinical TNM stage ( P = .04), as well as higher composite, emotional, functional, and physical MDADI scores ( P = .017, .046, .013, and .05, respectively). Conclusion: Patients with OPSCC who were treated with NAC+S achieved satisfactory long-term swallowing outcomes. Unilateral neck dissection was significantly associated with higher MDADI scores in this patient cohort.