Swallowing Function Following Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharyngeal Carcinoma: A 2-Year Follow-up

Otolaryngol Head Neck Surg. 2022 Aug;167(2):298-304. doi: 10.1177/01945998211057430. Epub 2021 Nov 9.

Abstract

Objective: To evaluate 2-year follow-up swallowing function in patients with human papillomavirus-related oropharyngeal squamous cell carcinoma (HPV+ OPSCC) who completed neoadjuvant chemotherapy and transoral robotic surgery (NAC+S).

Study design: Retrospective analysis of patients with OPSCC treated with NAC+S between 2010 and 2021.

Setting: A single academic institution.

Methods: This is a cross-sectional study of patient-reported swallowing function, assessed with the MD Anderson Dysphagia Inventory (MDADI) at least 2 years after completion of treatment. The inclusion criteria are patients with HPV+ OPSCC who underwent NAC+S at least 2 years ago. Those requiring adjuvant radiation or chemoradiation or experiencing relapse were excluded from the study.

Results: Completed MDADIs were received from 37 patients at a median 3.8 years posttreatment (interquartile range, 2.0-8.6 years). Of those, 94.6% (n = 35) were male and 81.1% (n = 30) were White. The median age at OPSCC diagnosis was 59.0 years (interquartile range, 41-80 years). The most frequent primary subsite of OPSCC was the base of the tongue (n = 20, 54.1%), followed by the tonsils (n = 16, 43.2%). In addition, 75.7% (n = 28) had stage IVa disease (TNM seventh edition), and 29 (78.4%) had scores ≥80, classified as optimal function. When compared with patients who received bilateral neck dissection, patients who received unilateral neck dissection were associated with an age <65 years old (P = .036) and lower clinical TNM stage (P = .04), as well as higher composite, emotional, functional, and physical MDADI scores (P = .017, .046, .013, and .05, respectively).

Conclusion: Patients with OPSCC who were treated with NAC+S achieved satisfactory long-term swallowing outcomes. Unilateral neck dissection was significantly associated with higher MDADI scores in this patient cohort.

Keywords: MD Anderson Dysphagia Inventory (MDADI); neoadjuvant chemotherapy; oropharyngeal squamous cell carcinoma; swallowing; transoral robotic surgery.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell* / drug therapy
  • Carcinoma, Squamous Cell* / surgery
  • Cross-Sectional Studies
  • Deglutition
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neoadjuvant Therapy
  • Neoplasm Recurrence, Local / etiology
  • Oropharyngeal Neoplasms* / drug therapy
  • Oropharyngeal Neoplasms* / surgery
  • Papillomavirus Infections*
  • Retrospective Studies
  • Robotic Surgical Procedures* / adverse effects