Author(s)
Austin C. Cao, BA
Joseph S. Lu, BS
David Shimunov, MD
Lova Sun, MD
Robert M. Brody, MD
Affiliation(s)
Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania;
Abstract:
Objectives: To describe swallowing and nutrition outcomes in patients with high-risk oropharyngeal cancer treated with trimodality therapy (TMT), including transoral robotic surgery (TORS) and adjuvant chemoradiotherapy.
Study Design: Retrospective cohort study.
Methods: Chart review was conducted on patients with HPV?+?OPSCC receiving TMT with TORS at an academic medical center from March 2007 to March 2021. Data collected included demographics, treatment, feeding tube placement, functional oral intake scale (FOIS) scores, and swallowing-language pathology (SLP) evaluations. Data was analyzed with descriptive statistics and chi-squared tests.
Results: A total of 226 patients met selection criteria, with median age of 60 years and 88% (198/226) were male. An intraoperative nasogastric (NG) tube was placed in 94% (213/226) of patients, and 35% (80/226) remained NG tube dependent longer than 3 weeks. PEG tube was placed in 19% (44/226). At one year after end-of-treatment, 5% (12/226) remained tube-dependent. Median FOIS scores were 7 at pre-op visit, 2 at first post-op visit, 6 at 1 year, and 7 at most recent follow-up visit. Only 60% (135/226) received an SLP evaluation between EOT and 1 year after surgery. Overall, 18% (40/226) showed signs of aspiration/penetration during at least one SLP evaluation. Surgical factors, including free-flap reconstruction, delayed NG tube removal, and low post-operative FOIS were predictive of finding signs of aspiration/penetration during at least one SLP visit.
Conclusions: Patients with HPV-associated OPSCC who underwent TMT experienced low rates long-term feeding tube dependence and deficits in functional oral intake. Post-surgical factors, are early predictors of swallowing dysfunction during and after adjuvant treatment.
Educational Objective: Participants should understand the benefits and drawbacks of trimodality therapy in advanced HPV+ head and neck cancer in the context of swallowing and functional oral intake outcomes.