Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Cancer Med. 2021 Jan;10(2):483-495. doi: 10.1002/cam4.3599. Epub 2020 Dec 4.
Functional and QoL outcomes were compared longitudinally in a cohort of patients treated for oropharyngeal squamous cell carcinoma (OPSCC) with primary transoral robotic surgery (TORS) or radiotherapy (RT). Forty-four patients undergoing primary TORS (n = 31) or RT (n = 13) for any stage OPSCC were included. Only low-stage disease was treated with TORS. Functional outcomes were: salivary flow rate, image-based swallowing function, and a self-reported 10-point scale comparing current swallowing function to baseline (CvB scale). QoL was assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30), Head & Neck Module (EORTC QLQ-HN35), and MD Anderson Dysphagia Inventory (MDADI). Shoulder impairment was assessed with Neck Dissection Impairment Index (NDII) and Oxford Shoulder Score (OSS). In the RT group, salivary flow rates had significantly declined at 12-month follow-up, with the biggest declines in QoL subscale scores recorded in the RT group for dry mouth and sticky saliva. Swallowing function on imaging studies was overall good, with no severe dysphagia within 1 year although, both treatment groups showed significant deterioration relative to baseline at the 12-month follow-up with increased DIGEST scores and pharyngeal retention. Shoulder impairment was rare at 1 year in both groups. A comprehensive examination of this cohort treated for OPSCC showed overall good functional and QoL outcomes 1 year after treatment. However, persistent impairment was seen in both groups with regards to swallowing function. In the TORS group, at 12-months follow-up, the QoL questionnaires showed worse scores in only one subscale (sticky saliva).
比较了经口机器人手术(TORS)或放疗(RT)治疗的口咽鳞状细胞癌(OPSCC)患者队列的功能和生活质量结果。纳入了 44 例接受原发 TORS(n=31)或 RT(n=13)治疗的任何分期 OPSCC 患者。仅低分期疾病采用 TORS 治疗。功能结果包括:唾液流率、基于图像的吞咽功能和比较当前吞咽功能与基线的 10 分制(CvB 量表)。生活质量采用欧洲癌症研究与治疗组织生活质量问卷核心量表(EORTC QLQ-C30)、头颈部模块(EORTC QLQ-HN35)和 MD 安德森吞咽障碍量表(MDADI)进行评估。肩部损伤采用颈部清扫术损伤指数(NDII)和牛津肩部评分(OSS)进行评估。在 RT 组中,唾液流率在 12 个月随访时明显下降,RT 组的口干和粘痰 QoL 子量表评分下降最大。影像学研究中的吞咽功能总体良好,尽管 1 年内没有严重吞咽困难,但两组在 12 个月随访时与基线相比均有明显恶化,DIGEST 评分增加,咽后滞留。两组在 1 年内肩部损伤均罕见。对该 OPSCC 患者队列的综合检查显示,治疗 1 年后功能和生活质量总体良好。然而,两组在吞咽功能方面均存在持续损伤。在 TORS 组中,12 个月随访时,只有一个子量表(粘痰)的 QoL 问卷显示出更差的评分。