2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Reprinted by permission of Laryngoscope. 2018; 128(2):403-411.

The Laryngoscope V C 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Quality of Life Outcomes of Transoral Robotic Surgery With or Without Adjuvant Therapy for Oropharyngeal Cancer

Rishabh Sethia, BS ; Ali C. Yumusakhuylu, MD; Isa Ozbay, MD; Virginia Diavolitsis, MD; Nicole V. Brown, MS; Songzhu Zhao, MS; Lai Wei, PhD; Matthew Old, MD; Amit Agrawal, MD; Theodoros N. Teknos, MD; Enver Ozer, MD

Objectives/Hypothesis: To compare quality of life (QOL) of patients who underwent transoral robotic surgery (TORS) alone, with adjuvant radiation therapy (RT), or adjuvant chemoradiation therapy (CRT) in the treatment of oropharyngeal squamous cell cancer (OPSCCA). Study Design: Prospective cohort study. Methods: Medical records were reviewed for 111 patients treated for OPSCCA from 2008 to 2015. Patients were admin- istered the Head and Neck Cancer Inventory (HNCI) to evaluate QOL preoperatively, and at 3 weeks, 3 months, 6 months, and 1 year postsurgery. QOL data were compared between 13 patients treated with TORS alone, 31 with adjuvant RT, and 67 with adjuvant CRT by a linear mixed effects model. Results: Mean follow-up was 35 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 80%, 60%, 55%, and 46%, respectively. TORS alone reported significantly higher eating scores than adjuvant RT or CRT at 3 and 6 months, and higher speech scores compared to adjuvant CRT at 3 months and adjuvant RT at 6 months. TORS alone and adju- vant RT reported less social disruption compared to adjuvant CRT at 3 months. Adjuvant CRT had consistently lower overall QOL scores until 6 months. No TORS-alone patient required percutaneous endoscopic gastrostomy, and no study patient required tracheostomy during treatment. Conclusions: TORS alone maintained higher QOL than adjuvant RT or CRT in eating, social function, speech, and overall QOL postsurgery. QOL and functional metrics were better for 6 months in TORS-alone patients, and at 12 months, the differ- ences were not significant. Key Words: Transoral robotic surgery, oropharyngeal cancer, quality of life, adjuvant therapy. Level of Evidence: 4. Laryngoscope , 128:403–411, 2018

INTRODUCTION Prior to the advent of transoral robotic surgery (TORS), oropharyngeal squamous cell cancer (OPSCCA) was historically treated with primary open surgical approaches or with primary radiation therapy (RT)/che- moradiation therapy (CRT). Using these interventions, patients often suffered cosmetic deformity, toxicities affecting oropharyngeal and laryngeal function, and sig- nificant declines in health-related quality of life (QOL). 1–6 In the last decade, TORS has emerged as a minimally invasive treatment option that preserves opti- mal patient function and long-term QOL. 6–9 This proce- dure was introduced to head and neck oncology by Weinstein et al., and has since been regarded as a safe, clinically superior, and cost-effective treatment option for a variety of head and neck pathologies, especially with respect to OPSCCA. 10–13 Following TORS, many patients receive postopera- tive RT or concurrent CRT based on high-risk features discovered upon clinical and pathologic evaluation. This adjuvant therapy has been associated with many adverse events such as gastrostomy tube dependence due to organ disruption and loss of function, 14 as well as

From the College of Medicine ( R . S .), The Ohio State University, Columbus, Ohio, U.S.A.; Department of Otolaryngology–Head and Neck Surgery ( A . C . Y .), Marmara University Faculty of Medicine, Istanbul, Tur- key; Department of Otolaryngology ( I . O .), Dumlupinar University, Kutahya, Turkey; Department of Radiation Oncology ( V . D .), The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Cen- ter for Biostatistics, Department of Biomedical Informatics ( N . V . B ., S . Z ., L . W .), The Ohio State University, Columbus, Ohio, U.S.A.; Department of Otolaryngology–Head and Neck Surgery ( A . C . Y ., I . O ., M . O ., A . A ., T . N . T ., E . O .), The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.; Comprehensive Cancer Center ( M . O ., A . A ., T . N . T ., E . O .), James Can- cer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A. Editor’s Note: This Manuscript was accepted for publication on June 19, 2017. This work was performed in the Department of Otolaryngology– Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A. Presented at the Triological Society Combined Sections Meeting, Miami Beach, Florida, U.S.A., January 22–24, 2016. Rishabh Sethia received financial support from the Barnes Research Scholarship at The Ohio State University College of Medicine. Ali Cemal Yumusakhuylu, MD, received financial support from The Sci- entific and Research Council of Turkey (TUBITAK). The authors have no other funding, financial relationships, or con- flicts of interest to disclose. Send correspondence to Enver Ozer, MD, Department of Otolaryn- gology–Head and Neck Surgery, The Ohio State University Wexner Med- ical Center, 320 W 10th Avenue, Starling Loving Hall, Room B216, Columbus, OH 43210. E-mail: enver.ozer@osumc.edu

DOI: 10.1002/lary.26796

Laryngoscope 128: February 2018

Sethia et al.: QOL Outcomes of TORS for Oropharyngeal Cancer

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