Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatstics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Otolaryngol Head Neck Surg. 2022 Sep;167(3):484-493. doi: 10.1177/01945998211059967. Epub 2021 Nov 16.
The primary course of treatment for patients with low- to intermediate-risk tonsil cancer has evolved with a shift toward primary transoral robotic surgery (TORS) or radiation therapy (RT). While favorable outcomes have been reported after deintensification via unilateral TORS or RT (uniRT), comparisons of functional outcomes between these treatments are lacking. We compared clinical outcomes (Dynamic Imaging Grade of Swallowing Toxicity [DIGEST] and feeding tube [FT]) and patient-reported swallowing outcomes (MD Anderson Dysphagia Inventory [MDADI]) based on primary treatment strategy: TORS, uniRT, or bilateral RT (biRT).
Secondary analysis of prospective cohort.
Single institution.
The study sample comprised 135 patients with HPV/p16+ T1-T3, N0-2b (American Joint Committee on Cancer, seventh edition), N0-1 (eighth edition) squamous cell carcinoma of the tonsil were sampled from a prospective registry. Modified barium swallow studies graded per DIGEST, FT placement and duration, and MDADI were collected.
Baseline DIGEST grade significantly differed among treatment groups, with higher dysphagia prevalence in the TORS group (34%) vs the biRT group (12%, = .04). No significant group differences were found in DIGEST grade or dysphagia prevalence at subacute and longitudinal time points ( = .41). Mean MDADI scores were similar among groups at baseline (TORS, 92; uniRT, 93; biRT, 93; = .90), subacute (TORS, 83; uniRT, 88; biRT, 82; = .38) and late time points (TORS, 86; uniRT, 86; biRT, 87; = .99). FT placement and duration significantly differed among primary treatment groups (FT [median days]: TORS, 89% [3]; uniRT, 8% [82]; biRT, 37% [104]; < .001).
While TORS and uniRT offer optimal functional outcomes related to dysphagia, results suggest that no measurable clinician-graded or patient-reported differences in swallow outcomes exist among these primary treatment strategies and biRT. Aside from baseline differences that drive treatment selection, differences in FT rate and duration by primary treatment strategy likely reflect diverse toxicities beyond dysphagia.
对于低危到中危扁桃体癌患者，主要治疗方案已经演变为经口机器人手术（TORS）或放疗（RT）。虽然通过单侧 TORS 或 RT（uniRT）减量化后可获得良好的结果，但这些治疗方法的功能结果比较仍缺乏研究。我们比较了基于主要治疗策略的临床结果（吞咽毒性动态成像分级[DIGEST]和喂养管[FT]）和患者报告的吞咽结果（MD 安德森吞咽障碍指数[MDADI]）：TORS、uniRT 或双侧 RT（biRT）。
前瞻性队列的二次分析。
单中心。
从一个前瞻性登记处中抽取了 135 例 HPV/p16+T1-T3、N0-2b（美国癌症联合委员会，第七版）、N0-1（第八版）扁桃体鳞状细胞癌患者进行样本分析。收集改良的钡剂吞咽研究，根据 DIGEST、FT 放置和持续时间以及 MDADI 进行分级。
治疗组间的基线 DIGEST 分级有显著差异，TORS 组的吞咽困难发生率较高（34%），而 biRT 组为 12%（=.04）。在亚急性和纵向时间点，DIGEST 分级或吞咽困难发生率无显著组间差异（=.41）。基线时各组间 MDADI 评分相似（TORS，92；uniRT，93；biRT，93；=.90），亚急性（TORS，83；uniRT，88；biRT，82；=.38）和晚期时间点（TORS，86；uniRT，86；biRT，87；=.99）。FT 放置和持续时间在主要治疗组之间有显著差异（FT [中位数天数]：TORS，89%[3]；uniRT，8%[82]；biRT，37%[104]；<.001）。
虽然 TORS 和 uniRT 在吞咽困难相关的功能结果方面具有优势，但结果表明，在这些主要治疗策略和 biRT 中，没有可测量的临床医生分级或患者报告的吞咽结果存在差异。除了驱动治疗选择的基线差异外，FT 率和持续时间的主要治疗策略差异可能反映了除吞咽困难以外的多种毒性。
