TY - JOUR
T1 - A Prospective Study of Mucosal Sparing Radiation Therapy in Resected Oropharyngeal Cancer Patients
AU - Anderson, Justin D.
AU - DeWees, Todd A.
AU - Ma, Daniel J.
AU - Nagel, Thomas H.
AU - Van Abel, Kathryn M.
AU - Moore, Eric J.
AU - Rwigema, Jean Claude M.
AU - Routman, David M.
AU - Wittich, Michelle Neben
AU - McGee, Lisa A.
AU - Hayden, Richard E.
AU - Foote, Robert L.
AU - Golafshar, Michael
AU - Gamez, Mauricio E.
AU - Lester, Scott C.
AU - Anand, Aman
AU - Crujido, Lisa R.
AU - Halyard, Michele Y.
AU - Hinni, Michael L.
AU - Patel, Samir H.
N1 - Funding Information:
This study was supported by Mayo Clinic Marley Endowment funds.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Purpose: Our objective was to report the prospective results of mucosal sparing radiation therapy in human papillomavirus–related oropharyngeal squamous cell carcinoma. Methods and Materials: From March 2016 through May 2019, patients were enrolled in this institutional review board–approved prospective cohort study at a multisite institution. Inclusion criteria included p16+ American Joint Committee on Cancer seventh edition pathologic T1 or T2, N1 to N3, and M0 oropharyngeal cancers. Proton therapy (PT) was delivered to at-risk nodal regions, excluding the primary mucosal site. Secondary to insurance denial for PT, intensity modulated radiation therapy (IMRT) was allowed. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module and Patient-Reported Outcomes Measurement Information System surveys (quality of life [QOL]) and modified barium swallowing impairment profiles (MBSImP) were obtained at baseline before radiation therapy, then 3 and 12 months after radiation therapy. Kaplan-Meier estimates were calculated for time-to-event clinical outcomes, and repeated measures mixed models were used to explore changes in QOL over time. A comparison of QOL and swallowing outcomes with standard-of-care treatment was analyzed. Results: There were 61 evaluable patients with a median follow-up of 38 months (range, 10-64); 44 (72%) were treated with PT and 17 (28%) were treated with IMRT. The 2-year local control, locoregional control, distant metastasis–free survival, and overall survival were 98%, 97%, 98%, and 100%, respectively. There were 6 grade ≥3 events related to treatment. Two IMRT patients required percutaneous endoscopic gastrostomy tube placement during treatment secondary to significant nausea due to dysgeusia. Patients noted significant QOL improvement over time in the pain, swallowing, speech, social eating, social contact, mouth opening, and use of pain medication domains (all P <.02). The MBSImP overall severity score as well as oral and pharyngeal impairment scores showed stability with no significant change over time. For the 44 patients treated with PT, the mean D95 to the primary target was 10.7 Gy (standard deviation = 12.5 Gy). Conclusions: Mucosal sparing radiation is well tolerated in select resected human papillomavirus–related oropharyngeal squamous cell carcinoma with a low risk of recurrence at the mucosal primary site, a low rate of percutaneous endoscopic gastrostomy tube placement, and few radiation-related grade ≥3 adverse events.
AB - Purpose: Our objective was to report the prospective results of mucosal sparing radiation therapy in human papillomavirus–related oropharyngeal squamous cell carcinoma. Methods and Materials: From March 2016 through May 2019, patients were enrolled in this institutional review board–approved prospective cohort study at a multisite institution. Inclusion criteria included p16+ American Joint Committee on Cancer seventh edition pathologic T1 or T2, N1 to N3, and M0 oropharyngeal cancers. Proton therapy (PT) was delivered to at-risk nodal regions, excluding the primary mucosal site. Secondary to insurance denial for PT, intensity modulated radiation therapy (IMRT) was allowed. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module and Patient-Reported Outcomes Measurement Information System surveys (quality of life [QOL]) and modified barium swallowing impairment profiles (MBSImP) were obtained at baseline before radiation therapy, then 3 and 12 months after radiation therapy. Kaplan-Meier estimates were calculated for time-to-event clinical outcomes, and repeated measures mixed models were used to explore changes in QOL over time. A comparison of QOL and swallowing outcomes with standard-of-care treatment was analyzed. Results: There were 61 evaluable patients with a median follow-up of 38 months (range, 10-64); 44 (72%) were treated with PT and 17 (28%) were treated with IMRT. The 2-year local control, locoregional control, distant metastasis–free survival, and overall survival were 98%, 97%, 98%, and 100%, respectively. There were 6 grade ≥3 events related to treatment. Two IMRT patients required percutaneous endoscopic gastrostomy tube placement during treatment secondary to significant nausea due to dysgeusia. Patients noted significant QOL improvement over time in the pain, swallowing, speech, social eating, social contact, mouth opening, and use of pain medication domains (all P <.02). The MBSImP overall severity score as well as oral and pharyngeal impairment scores showed stability with no significant change over time. For the 44 patients treated with PT, the mean D95 to the primary target was 10.7 Gy (standard deviation = 12.5 Gy). Conclusions: Mucosal sparing radiation is well tolerated in select resected human papillomavirus–related oropharyngeal squamous cell carcinoma with a low risk of recurrence at the mucosal primary site, a low rate of percutaneous endoscopic gastrostomy tube placement, and few radiation-related grade ≥3 adverse events.
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U2 - 10.1016/j.ijrobp.2022.06.057
DO - 10.1016/j.ijrobp.2022.06.057
M3 - Article
C2 - 36309077
AN - SCOPUS:85144036785
VL - 115
SP - 192
EP - 201
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 1
ER -