Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Patient-Reported Swallowing Outcomes in HPV+ Oropharyngeal Cancer by Postoperative Chemoradiation Dose in MINT and E3311.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Tharakan Theresa, Puram Sidharth V, Paniello Randal C, Pipkorn Patrik, Zolkind Paul, Harbison Richard Alexander, Adkins Douglas, Oppelt Peter, Thorstad Wade, Gay Hiram, Apicelli Anthony J, Moravan Michael J, Chernock Rebecca, Mansour Mena, Ley Jessica, Jackson Ryan S
Аннотация
OBJECTIVE: Evaluate the effect of deintensified postoperative adjuvant (chemo)radiation therapy (POA(C)RT) on patient-reported dysphagia outcomes in patients with human papillomavirus (HPV+) oropharyngeal squamous cell carcinoma (OPSCC).
STUDY DESIGN: Retrospective.
SETTING: Multiple institutions, 2014 to 2021.
METHODS: Patients with HPV+ OPSCC underwent transoral robotic surgery and reduced-dose POA(C)RT by pathologic risk stratification. The Minimalist Trial (MINT) participants received 42 Gy radiation therapy (RT) with one dose of cisplatin 100 mg/m2 (intermediate-risk arm) or no cisplatin (low-risk arm). The intermediate-risk E3311 participants were randomized to 50 or 60 Gy RT. Analysis was per-protocol by RT dose group. The primary outcome was change in MD Anderson Dysphagia Inventory (MDADI) composite score from baseline to 1-year posttreatment, with a clinically meaningful decline (CMD) of ≥10 points.
RESULTS: In total, 156 included patients received POA(C)RT: n = 28 at 42 to 49 Gy (n = 19 no cisplatin, n = 9 cisplatin), n = 82 at 50 to 59, and n = 46 at 60 Gy. Mean (SD) change in MDADI was -7.2 (10.6) in the 42 to 49 Gy group, -11.3 (17.2) in the 50 to 59 group, and -9.1 (15.1) in the 60 Gy group (analysis of variance [ANOVA] P = .46). The rate of CMD was 11/28 (39%) in the 42 to 49 Gy group, 43/82 (52%) in the 50 to 59 group, and 20/46 (44%) in the 60 Gy group (chi-square P = .42). The rate of CMD was similar in those receiving 42 to 49 Gy with (3/9, 33%) and without cisplatin (8/19, 42%) (diff. 1%, 95% CI -29% to 47%). Gastrostomy tube rates were similar across dose groups.
CONCLUSION: Changes in dysphagia-related quality-of-life (MDADI) from baseline to 1 year after POA(C)RT did not differ by radiation dose in the range of 42 to 60 Gy.
STUDY DESIGN: Retrospective.
SETTING: Multiple institutions, 2014 to 2021.
METHODS: Patients with HPV+ OPSCC underwent transoral robotic surgery and reduced-dose POA(C)RT by pathologic risk stratification. The Minimalist Trial (MINT) participants received 42 Gy radiation therapy (RT) with one dose of cisplatin 100 mg/m2 (intermediate-risk arm) or no cisplatin (low-risk arm). The intermediate-risk E3311 participants were randomized to 50 or 60 Gy RT. Analysis was per-protocol by RT dose group. The primary outcome was change in MD Anderson Dysphagia Inventory (MDADI) composite score from baseline to 1-year posttreatment, with a clinically meaningful decline (CMD) of ≥10 points.
RESULTS: In total, 156 included patients received POA(C)RT: n = 28 at 42 to 49 Gy (n = 19 no cisplatin, n = 9 cisplatin), n = 82 at 50 to 59, and n = 46 at 60 Gy. Mean (SD) change in MDADI was -7.2 (10.6) in the 42 to 49 Gy group, -11.3 (17.2) in the 50 to 59 group, and -9.1 (15.1) in the 60 Gy group (analysis of variance [ANOVA] P = .46). The rate of CMD was 11/28 (39%) in the 42 to 49 Gy group, 43/82 (52%) in the 50 to 59 group, and 20/46 (44%) in the 60 Gy group (chi-square P = .42). The rate of CMD was similar in those receiving 42 to 49 Gy with (3/9, 33%) and without cisplatin (8/19, 42%) (diff. 1%, 95% CI -29% to 47%). Gastrostomy tube rates were similar across dose groups.
CONCLUSION: Changes in dysphagia-related quality-of-life (MDADI) from baseline to 1 year after POA(C)RT did not differ by radiation dose in the range of 42 to 60 Gy.