Achim V, et al. - The researchers carried out a comparative assessment of the functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing transoral robotic surgery (TORS) only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT) in patients with oropharyngeal cancer. Poorer long-term outcomes with continued dysphagia were reported by patients who underwent TORS+CRT, more than 1 year after surgery. The yielded data supported the analysis of adjuvant de-escalation therapies in order to reduce the long-term adverse effects of the treatment.

Methods

• The design of this trial was a prospective, longitudinal cohort study.
• It was carried out from June 1, 2013, through November 31, 2015 at a single tertiary academic hospital.
• The enrollees consisted of 74 patients undergoing TORS for initial treatment of OPSCC .
• The main outcome measure included data collectionat baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months).
• The quality-of-life metrics comprised of the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument.
• In addition, data were cumulated with regard to the tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients.

Results

• This study recruited 74 patients (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months).
• The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up.
• All 3 groups reported a substantial worsening in pain and all swallowing-related measures postoperatively.
• Subsequent improvement was discovered over time, with varied trajectories noted across the 3 intervention groups.
• A marked improvement was found in the postoperative dysphagia, more rapidly in the TORS-only group.
• At long-term follow-up, variation was disclosed in the weight loss between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically significant way.
• The TORS-only group reported noteably better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3).