Surgery and Radiotherapy Generate Similar Long-Term PROs in OPSCC

Michael J. Dohopolski, MD

Long-term assessments did not reveal differences in patient-reported outcomes (PROs) between primary surgery or radiotherapy for patients with oropharyngeal squamous cell carcinoma (OPSCC), according to findings from a population-based cohort study published in JAMA Otolaryngology–Head & Neck Surgery.¹

In an analysis of 396 OPSCC survivors, the median total MD Anderson Symptom Inventory (MDASI)–Head and Neck score associated with primary radiotherapy (n = 296) was 1.68 (IQR, 0.64-4.43). The median MDASI score associated with surgery (n = 127) was 1.52 (IQR, 0.43-3.68), yielding a median difference of 0.25 (95% CI, –0.07 to 0.61). No significant differences were identified with the MDASI after adjusting for sex or age (β, −0.1; 95% CI, −0.7 to 0.6).

Similarly, in assessing patients via the Neck Dissection Disability Index (NDDI), no significant differences in PROs were reported in patients who received either primary radiotherapy or surgery (β, −1.7; 95% CI, −6.7 to 3.4). Treatment modality did not change the outcomes for patients in the Effectiveness of Auditory Rehabilitation (EAR) scale either (β, −0.9; 95% CI, −7.7 to 5.8).

Of note, lower socioeconomic status, feeding tube use, and chemotherapy exposure were associated with worse long-term PROs.

“We found that long-term PROs were consistently similar between the 2 treatment modalities,” Michael J. Dohopolski, MD, of the Department of Radiation Oncology, The University of Texas Southwestern Medical Center, and co-investigators, wrote in the study. “On the other hand, the study findings suggest an association of income and education with multiple domains of QOL [quality of life], and in a relatively novel finding, we identified a significant association between concurrent chemotherapy and worse long-term PROs.”

According to the study authors, the optimal treatment strategy for patients with OPSCC is in flux1 and that the best strategy may include definitive radiotherapy or chemoradiotherapy or resection of the primary tumor and neck dissection as best standard of care for these patients.²

Both of these options are associated with excellent long-term outcomes, with comparable disease control rates. However, because there is no clear advantage with 1 strategy over the other, adverse event (AE) profiles can play a key role in clinician and patient decision making.

In this study, investigators mailed questionnaires to 1600 OPSCC survivors who were registered with the Texas Cancer Registry. The questionnaires included demographic and treatment questions, along with the MDASI module, the NDII, and the EAR scale. They received a total of 400 responses, 183 (46.2%) of which represented survivors who had received their initial diagnosis over 8 to 15 years ago before.

For a patient response to be evaluable, the patient needed to be at least 18 years of age, alive as of 2018, a Texas resident, have had a Surveillance, Epidemiology, and End Results(SEER) summary cancer stage of I to III, and to have been treated with either radiotherapy or primary surgery without postoperative radiotherapy.

Among the 396 evaluable patient responses, 52.0% (n = 206) were older than 57 years, and 52.8% (n = 209) were nonsmokers. Most respondents were men (81.8%), married (72.7%), and White (84.6%). Eleven participants were Black, 28 were Hispanic, and 12 were another ethnicity. Most patients had not received a college degree (59.8%) and lived in a metropolitan area (85.1%). Additionally, most respondents were positive for human papillomavirus (52.8%).

A larger percentage of patients who had received primary surgery were older than 57 years than in the radiotherapy group (56.9% vs 41.7%). A total of 53.3% of patients had received a feeding tube during treatment, but very few needed it long term (4.3%).

Of note, patients who did not have a college degree were more likely to have worse core MDASI scores (β, 0.8; 95% CI, 0.3-1.4), head and neck MDASI scores (β, 0.7; 95% CI, 0.2-1.3), and interference MDASI scores (β, 0.8; 95% CI, 0.2-1.5). Worse MDASI scores were also reported in patients who had received cisplatin (β, 0.9; 95% CI, 0.0-1.8) or who had a primary tumor on the base of their tongue (β, 0.7; 95% CI, 0.1-1.3).

A multivariable regression of the NDII findings demonstrated that patients had worse NDII scores if they had less education (β, −6.6; 95% CI, −11.2 to −2.0), lower income (β, −5.0; 95% CI, −9.8 to −0.1), current feeding tube use (β, −35.0; 95% CI, −50.3 to −19.8), Hispanic ethnicity (β, −9.5; 95% CI, −18.2 to −0.7), or identified as other ethnicity (β, −26.2; 95% CI, −52.2 to −0.1).

Similarly, a multivariable regression model of the EAR findings showed that patients were more likely to have lower EAR scores if they were male, had lower income (β, −11.1; 95% CI, −17.4 to −4.8), or had past feeding tube use (β, −8.7; 95% CI, −14.9 to −2.5). They were also likely to have worse EAR scores if they had prior treatment with cisplatin (β, −9.6; 95%CI, −18.7 to −0.6).These findings remained consistent in a sensitivity analysis.

References

1. Dohopolski MJ, Diao K, Hutcheson KA, et al. Long-term patient-reported outcomes in a population-based cohort following radiotherapy vs surgery for oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. Published online June 29, 2023. doi:10.1001/jamaoto.2023.1323
2. NCCN. Clinical Practice Guidelines in Oncology.Head and neck cancer, version 2.2023. Accessed July 12, 2023. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf