Functional Outcomes in Patients with Human Papillomavirus-Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Joseph S Lu; Austin C Cao; David Shimunov; Lova Sun; John N Lukens; Alexander Lin; Roger B Cohen; Devraj Basu; Steven B Cannady; Karthik Rajasekaran; Gregory S Weinstein; Robert M Brody

doi:10.1002/lary.30714

Functional Outcomes in Patients with Human Papillomavirus-Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

Laryngoscope. 2023 Nov;133(11):3013-3020. doi: 10.1002/lary.30714. Epub 2023 May 2.

Authors

Joseph S Lu^{1

2}, Austin C Cao^{2

3}, David Shimunov², Lova Sun⁴, John N Lukens⁵, Alexander Lin⁵, Roger B Cohen⁴, Devraj Basu², Steven B Cannady², Karthik Rajasekaran², Gregory S Weinstein², Robert M Brody²

Affiliations

¹ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
² Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Medicine - Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 37129315
DOI: 10.1002/lary.30714

Abstract

Objectives: To describe swallowing and feeding-tube outcomes in patients with high-risk oropharyngeal cancer treated with trimodality therapy (TMT), including transoral robotic surgery (TORS) and adjuvant chemoradiotherapy.

Methods: A chart review was conducted on patients with HPV+ OPSCC receiving TMT with TORS at an academic medical center from March 2010 to March 2021. Data collected included demographics, treatment, feeding tube placement, functional oral intake scale (FOIS) scores, and swallowing-language pathology (SLP) evaluations.

Results: A total of 255 patients met selection criteria (mean age 61 years, 88% male). Following intraoperative nasogastric tube (NG) placement, 31% remained NG tube dependent after 3 weeks. A gastrostomy tube was placed in 19% of patients, and at 1 year after end-of-treatment (EOT), 3.5% overall remained tube-dependent. Mean FOIS scores were 6.9 (SD = 0.3) at pre-operative visit, 2.6 (1.8) at first post-operative visit, and 5.5 (1.5) after EOT. In the subset of patients with follow-up longer than 2 years (n = 118), the mean FOIS was 6.1 (SD = 1.3) at most recent visit. Clinical signs of aspiration/penetration were suspected on SLP evaluation in 18% of patients. These patients were subsequently evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) and/or barium swallow study, which confirmed signs of aspiration in 2.7% of patients overall. Delayed NG tube removal after 3 weeks was predictive of (1) gastrostomy tube requirement and (2) clinical signs of aspiration on an SLP visit after EOT.

Conclusions: Favorable functional and feeding-tube outcomes are demonstrated in patients with HPV-associated OPSCC undergoing TMT. In this single-institution study, we found low rates of long-term feeding tube dependence and high median FOIS following treatment. Review of routine SLP visits provides a detailed and easily accessible means for assessing swallowing function in this cohort.

Level of evidence: 4 Laryngoscope, 133:3013-3020, 2023.

Keywords: HPV positive oropharyngeal cancer; TORS; functional outcomes; head and neck cancer; transoral robotic surgery; trimodality.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Female
Head and Neck Neoplasms* / etiology
Human Papillomavirus Viruses
Humans
Male
Middle Aged
Oropharyngeal Neoplasms* / pathology
Papillomavirus Infections* / complications
Papillomavirus Infections* / therapy
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Squamous Cell Carcinoma of Head and Neck