Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution
Abstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary rad...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-020-01705-1 |
| _version_ | 1819229890936832000 |
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| author | Eric J. Di Gravio Pencilla Lang Hugh Andrew Jinwook Kim Tricia Chinnery Neil Mundi S. Danielle MacNeil Adrian Mendez John Yoo Kevin Fung Joe S. Mymryk John W. Barrett Nancy Read Varagur Venkatesan Sara Kuruvilla Lucas C. Mendez Eric Winquist Sylvia Mitchell Sarah A. Mattonen Anthony C. Nichols David A. Palma |
| author_facet | Eric J. Di Gravio Pencilla Lang Hugh Andrew Jinwook Kim Tricia Chinnery Neil Mundi S. Danielle MacNeil Adrian Mendez John Yoo Kevin Fung Joe S. Mymryk John W. Barrett Nancy Read Varagur Venkatesan Sara Kuruvilla Lucas C. Mendez Eric Winquist Sylvia Mitchell Sarah A. Mattonen Anthony C. Nichols David A. Palma |
| author_sort | Eric J. Di Gravio |
| collection | DOAJ |
| description | Abstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery. |
| first_indexed | 2024-12-23T11:20:22Z |
| format | Article |
| id | doaj.art-3b222f9a6b7849cfaa3f46309df045b6 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-23T11:20:22Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-3b222f9a6b7849cfaa3f46309df045b62022-12-21T17:49:05ZengBMCRadiation Oncology1748-717X2020-11-011511910.1186/s13014-020-01705-1Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institutionEric J. Di Gravio0Pencilla Lang1Hugh Andrew Jinwook Kim2Tricia Chinnery3Neil Mundi4S. Danielle MacNeil5Adrian Mendez6John Yoo7Kevin Fung8Joe S. Mymryk9John W. Barrett10Nancy Read11Varagur Venkatesan12Sara Kuruvilla13Lucas C. Mendez14Eric Winquist15Sylvia Mitchell16Sarah A. Mattonen17Anthony C. Nichols18David A. Palma19Department of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Oncology, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Medical Biophysics, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Oncology, Western UniversityDepartment of Oncology, Western UniversityDepartment of Oncology, Western UniversityDepartment of Oncology, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Oncology, Western UniversityDepartment of Oncology, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityDepartment of Otolaryngology – Head and Neck Surgery, Western UniversityAbstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.http://link.springer.com/article/10.1186/s13014-020-01705-1RadiationChemoradiationOropharyngeal cancerToxicity |
| spellingShingle | Eric J. Di Gravio Pencilla Lang Hugh Andrew Jinwook Kim Tricia Chinnery Neil Mundi S. Danielle MacNeil Adrian Mendez John Yoo Kevin Fung Joe S. Mymryk John W. Barrett Nancy Read Varagur Venkatesan Sara Kuruvilla Lucas C. Mendez Eric Winquist Sylvia Mitchell Sarah A. Mattonen Anthony C. Nichols David A. Palma Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution Radiation Oncology Radiation Chemoradiation Oropharyngeal cancer Toxicity |
| title | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
| title_full | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
| title_fullStr | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
| title_full_unstemmed | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
| title_short | Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution |
| title_sort | modern treatment outcomes for early t stage oropharyngeal cancer treated with intensity modulated radiation therapy at a tertiary care institution |
| topic | Radiation Chemoradiation Oropharyngeal cancer Toxicity |
| url | http://link.springer.com/article/10.1186/s13014-020-01705-1 |
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