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Three Primary Treatment Strategies Show No Differences in Swallow Outcome for Patients with Low- to Intermediate-Risk Tonsil Cancer

by Linda Kossoff •

What are the functional outcomes of dysphagia in low- to intermediate-risk tonsil cancer across transoral robotic surgery (TORS), unilateral radiation therapy (uniRT), and bilateral RT (biRT)?

BOTTOM LINE

While TORS and uniRT offer optimal functional dysphagia outcomes, there exist no measurable clinician-graded or patient-reported differences in swallow outcomes among these primary treatment strategies and bilateral biRT.

BACKGROUND: Human papilloma virus-related oropharynx cancers (OPCs) have better outcomes in tumor response, functional baseline swallowing, and survival, necessitating redesigned curative treatments for low- to intermediate-risk disease to prevent long-term toxicity. There have been favorable outcomes after deintensification via unilateral TORS and uniRT, but treatment outcome comparisons are lacking.

STUDY DESIGN: Secondary analysis of prospective cohort.

SETTING: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

SYNOPSIS: Researchers accessed March 2015–April 2019 data from a registry of patients with oropharyngeal malignancies of the head and neck. Their study sample comprised 135 patients (111 males, mean age 58 years) with low- to intermediate-risk squamous carcinoma of the tonsil, treated with primary TORS and RT. Dysphagia was graded by standardized modified barium swallow (MBS) review. Feeding tube (FT) status was recorded for all patients at standard time points, and patients completed a self-administered questionnaire at each MBS appointment. Patients were stratified by primary treatment of TORS (38), uniRT (37), or biRT (60). Clinical and patient-reported outcomes revealed a similar presence and prevalence of dysphagia and swallow-related quality of life at subacute and long-term time points, regardless of primary treatment strategy. Similar mean scores on patient-reported swallowing outcomes were observed among the three groups, with notably high average scores. Overall FT utilization was highest in the TORS group. Authors noted that FT rate and duration differences are likely driven by toxicities beyond swallowing impairment. Study limitations included some missing data and attrition, primarily at the 18- to 24-month time point.

CITATION: Barbon CEA, Yao CMK, Peterson CB, et al. Swallowing after primary TORS and unilateral or bilateral radiation for low- to intermediate-risk tonsil cancer. Otolaryngol Head Neck Surg. 2022;167:484–493.