Trends in Swallowing Outcomes Following Deintensified Treatment in Selected p16+ Oropharyngeal Carcinoma

Abstract

Abstract Objective Identify trends in swallowing outcomes in p16+ oropharyngeal squamous cell carcinoma following neoadjuvant chemotherapy+surgery (NAC+S) versus neoadjuvant chemotherapy+surgery+radiation (NAC+S+R). Study Design Cohort study. Setting Single academic institution. Methods Swallowing outcome was measured using a validated questionnaire, MD Anderson Dysphagia Inventory (MDADI). MDADI scores were compared between NAC+S and NAC+S+R groups in short‐term (3 years). Clinical factors associated with MDADI scores were explored using a linear mixed model. Statistical significance was established at p < .05. Results Sixty‐seven patients met the inclusion criteria and were divided into 2 groups: NAC+S (57 [85.1%]) and NAC+S+R (10 [14.9%]). All patients had improved MDADI scores in the middle‐term compared to short‐term (NAC+S: score increase = 3.43, p = .002; NAC+S+R: score increase = 11.18, p = .044), long‐term compared to short‐term (NAC+S: score increase = 6.97, p < .001; NAC+S+R: score increase = 20.35, p < .001), and long‐term compared to middle‐term (NAC+S: score increase = 3.54, p = .043; NAC+S+R: score increase = 9.18, p = .026). NAC+S patients had better MDADI scores than NAC+S+R patients at short‐term (83.80 vs 71.26, p = .001). There was no significant difference in swallowing function in the middle‐term or long‐term. Conclusion Regardless of treatment type, swallowing will likely be improved in the middle‐term and long‐term compared to the short‐term. Patients treated with NAC+S+R will have worse short‐term swallowing function. However, in the middle‐term and long‐term, there is no significant difference in swallowing function between patients treated with NAC+S and NAC+S+R.

Keywords

• MD Anderson Dysphagia Inventory
• oropharyngeal squamous cell carcinoma
• radiation
• swallowing
• transoral robotic surgery