Functional outcomes after treatment of advanced oropharyngeal carcinoma with radiation or chemoradiation.

PURPOSE: To report survival and longitudinal functional outcomes after radiation or chemoradiation in advanced-stage cancers of the oropharynx.

METHODS: A population-based cohort of 89 patients with stage III and IV oropharygeal carcinoma treated from 2003 to 2008 with conformal radiation or chemoradiation was followed. Patients were assessed with a standardized prospective clinical functional outcomes protocol pretreatment and at regular intervals posttreatment. The standard clinical functional outcomes protocol followed: performance status (Karnofsky Performance Status [KPS], Eastern Cooperative Oncology Group [ECOG]); swallowing status (performance status scale for head and neck cancer patients [PSS-HN] and Royal Brisbane Hospital Swallowing Scale [RBHOMS]); and speech (PSS-HN and Voice Handicap Index-10 [VHI-10]).

RESULTS: The primary site was the base of the tongue in 38 (43%) and tonsil or soft palate in 51 (57%) patients. Chemotherapy was used in 73%. The median follow-up was 3.4 years. At 3 years, overall survival was 72.3% and disease-free survival was 71.8%. Function reached a nadir at 3 months. At 36 months, the KPS was 90 or better in 76% and the ECOG was 0 in 75%. Total or partial feeding tube dependency ranged from 46% at 3 months to 3% at 2 years. Oral diet texture showed prolonged impairment, with 85% of survivors requiring a soft or semisolid diet with fluids at 36 months. Sixty-two percent were able to eat in public without restriction.

CONCLUSIONS: The majority of patients will have a good functional outcome after radiation or chemoradiation for advanced oropharyngeal carcinoma. We now have a functional benchmark to which we can compare the results of primary surgery and newer treatment techniques, such as intensity-modulated radiation treatment.