Study Finds Swallowing Function Optimal with Transoral Robotic Surgery and Proton Therapy for Oropharyngeal Cancer

Presenting author:
Carly EA Barbon, PhD

By Loren K. Mell, MD

Contemporary treatments for oropharyngeal cancer are leading to improved swallowing function, according to Carly Barbon, PhD, a speech pathologist and postdoctoral fellow working with Kate Hutcheson, PhD, and colleagues in the Departments of Head and Neck Surgery and Radiation Oncology at MD Anderson Cancer Center. In a longitudinal registry study involving 188 patients treated with transoral robotic surgery (TORS) or intensity modulated proton therapy (IMPT), they found that 12-month scores on the MD Anderson Dysphagia Symptom Inventory (MDADI) were best with TORS alone, although scores were favorable for both types of therapy. “Overall, a large proportion of patients fell within the optimal range for swallowing-related quality of life,” Barbon noted, with optimal scores considered to be MDADI score of 80 or above.

The results contrast with findings from the ORATOR trial, published in 2019, which found higher 12-month MDADI scores with radiation therapy as the primary modality, as opposed to TORS. In the ORATOR trial, the 6.8 point average difference in MDADI scores did not meet the threshold for a clinical difference, however. Barbon stressed that most patients on the ORATOR trial received multi-modality therapy ― where differences in swallowing outcomes may not be as apparent ― whereas patients in their cohort study were further stratified by multimodality. They found that the difference in MDADI scores was most pronounced in patients treated with TORS alone, with an average difference of 13.6 points, but cautioned that missing data and unmeasured confounding in non-randomized studies can disguise underlying differences. She emphasized the need for continued research, preferably randomized trials to evaluate and compare functional and patient-reported outcomes with these treatments. “Patients often come with pre-formed notions about which therapy they want,” Barbon lamented, making conducting randomized trials difficult.

Overall, Barbon found the results reassuring. “While our results indicate improved outcomes with TORS as a single modality, both modalities produced excellent results within the multimodality setting.” Her take-home message: “These contemporary treatments for favorable-risk, HPV-driven oropharyngeal cancers should both be considered optimal given our outcomes for swallowing function, with a large proportion of patients in the optimal range,” Barbon concluded.

Comparison of Prospective, Longitudinal Swallowing Function After Primary Intensity-modulated Proton Therapy (IMPT) or Transoral Robotic Surgery (TORS) for Oropharyngeal Squamous Cell Carcinoma was presented on Tuesday, October 27 in the Science Center, as part of Quick Pitch (QP) 16.

Published on: October 28, 2020