Swallowing Function After TLM + Adjuvant Therapy

For patients with advanced-stage oropharyngeal cancer, how does transoral laser microsurgery (TLM) + adjuvant therapy impact swallowing function?

Background: For survival reasons, patients with advanced oropharyngeal cancer have elected adjuvant therapy, which introduces treatment interventions known to acutely and chronically decrease swallowing ability. In recent years, minimally invasive surgical approaches, including

transoral laser microsurgery (TLM), have gained momentum in Europe and North America, but whether TLM retains swallowing function is unknown.

Study design: Retrospective analysis and longitudinal descriptive study of swallowing outcomes.

Setting: Department of Otolaryngology-Head and Neck Surgery and Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.

Synopsis: Of 118 patients who were treated with TLM from 1996–2008, 87 percent received adjuvant therapy. At one month following TLM, 97 patients (82 percent) had good swallowing. At three months, which coincided with the administration of adjuvant therapy, the percentage of patients with good swallowing dropped to 55 percent, then rose to 89 percent by the end of 12 months. At two, three, four and five years after surgery, the percentages of good swallowing were 88 percent, 88 percent, 90 percent and 93 percent.

While 55 percent of patients maintained consistently good swallowing function at all time points, 32 percent had poor swallowing function during cancer treatment and then recovered to good swallowing function. Nine patients (8 percent) had persistently poor swallowing function and 7 patients (6 percent) developed late-onset swallowing dysfunction.

The authors found that patients with oropharyngeal cancers of T-stages 1 through 3 who undergo TLM + adjuvant therapy have a high probability of good swallowing function (average 93 percent) at two years after surgery. Patients with T stage 4 tumors have the lowest probability of good swallowing (about 33-43 percent) at two years. There was no control group, so a comparison with standard therapy was not provided.

Bottom line: TLM + adjuvant therapy results in good swallowing function for oropharyngeal cancer patients with stages T 1-3 and poorer swallowing function for those with T stage 4.

Citation: Rich JT, Liu J, Haughey BH. Swallowing function after transoral laser microsurgery (TLM) + adjuvant therapy for advanced-stage oropharyngeal cancer. Laryngoscope. 2011;121(11):2381-2390.

—Reviewed by Sue Pondrom