Avoiding Radiation Therapy for HPV-OPSCC Can Help Quality of Life for Younger Patients

by Amy E. Hamaker  •

CLINICAL QUESTION

What is the quality of life (QOL) of patients with human papillomavirus virus−associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) who undergo transoral robotic surgery and neck dissection (NECTORS)?

BOTTOM LINE

Use of the NECTORS protocol is associated with excellent QOL outcomes for patients with HPV-OPSCC.

BACKGROUND: There is an increasing incidence of HPV-OPSCC. Most of these cases are treated with adjuvant radiation therapy (RT), which has been associated with substantial morbidity, including xerostomia, dental loss, and dysphagia. Considering that these patients are young and have a good prognosis, they may live for many years with post-treatment toxic effects.

STUDY DESIGN: Prospective cohort study.

SETTING: McGill University Health Centre and the Jewish General Hospital, Montreal, Canada.

SYNOPSIS: 94 eligible patients with stage III or IVa HPV-OPSCC were treated with the NECTORS protocol from 2017 to 2022. QOL questionnaires were given at baseline, and at one, three, six, 12, 18, and 24 months post-treatment. Sixty-seven patients who completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included in the final analysis. Among the 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male), the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Researchers found that, globally, QOL at 24 months improved compared with baseline (mean difference, 9.49; 95%CI, 2.45 to 16.53). All functional scores returned to baseline or improved within three to six months post-treatment and remained stable at 24 months. Symptom scale scores improved or were stable at 24 months. There was no significant global difference in dysphagia scores between baseline and 12 months (mean difference, 6.15; 95%CI, −4.18 to 16.49). Limitations included the possibility of baseline values being skewed because QOL questionnaires were filled out after a cancer diagnosis.

CITATION: Silver JA, Bouganim N, Richardson K, et al. Quality of life after neoadjuvant chemotherapy and transoral robotic surgery for oropharynx cancer. JAMA Otolaryngol Head Neck Surg. 2024;150:65–74.