Swallowing Function Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharyngeal Carcinoma: A 2-Year Follow-up

• Published in: Otolaryngology-head and neck surgery Vol. 167; no. 2; pp. 298 - 304
• Main 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.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-08-2022
• Subjects: MD Anderson Dysphagia Inventory (MDADI); neoadjuvant chemotherapy; oropharyngeal squamous cell carcinoma; swallowing; transoral robotic surgery; neoadjuvant chemotherapy; swallowing; MD Anderson Dysphagia Inventory (MDADI); transoral robotic surgery; oropharyngeal squamous cell carcinoma
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/01945998211057430

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.