(0634) Diet Texture Restrictiveness for Patients with Dysphagia Following a De-Escalated Treatment Modality for Oropharyngeal Cancer

Introduction: De-escalated treatment modalities for human papillomavirus-associated oropharyngeal cancers (HPV-OPC) are of increasing interest due to rising rates of HPV and favorable prognostic implications of HPV positivity. Neoadjuvant chemotherapy followed by transoral robotic surgery (NAC+TORS) has demonstrated superiority in patient-reported dysphagia and quality of life, but there is paucity in objective clinician recommended outcomes relative to the posttreatment degree of dysphagia.

Methods: This is a cross-sectional study at a single academic institution of diet texture related functional outcomes in HPV-OPC patients who completed NAC+TORS with surgical pathology-based adjuvant RT or primary concurrent chemoradiation (CCRT). Patients evaluated by SLP for dysphagia symptoms posttreatment were retrospectively reviewed for diet texture restrictiveness using the International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS). An ordinal logistic regression model was used to determine the likelihood of diet texture restrictiveness posttreatment adjusting for relevant covariates including age, race/ethnicity, treatment modality, stage, tumor subsite, neck dissection (unilateral vs bilateral), and smoking status.

Results: A total of 59 patients (mean age [SD], 64 [9.53] years; 50 [84.74%] male) were included in this cohort. Of the 7 predictor variables, only treatment modality was significantly associated with diet restrictiveness. Patients who underwent treatment modalities other than NACS+TORS had 0.261 higher odds of having a lower IDDSI-FDS (and more restrictive diet texture) categorization (95% CI, 0.072 to 0.944) relative to patients who underwent NAC+TORS only, χ2(1) = 4.194, p = 0.041.

Conclusions: We demonstrate favorable swallowing outcomes in patients with HPV-OPSCC receiving treatment with a novel de-escalated protocol employing neoadjuvant chemotherapy followed by TORS, as evidenced by reduced odds of requiring restrictive diet textures. Further studies in this cohort will compare patient reported dysphagia with IDDSI-FDS.