Primary Surgery vs Radiotherapy for Soft Palate Squamous Cell Carcinoma: A National Database Study

Saturday, September 28, 2024

10:00 AM – 10:06 AM EDT

Location: MBCC, 208

Disclosure(s):

Nrusheel Kattar, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ivan A A. Alvarez, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Srivatsa Surya Vasudevan, MD, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ameya A. Asarkar, MD, FACS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Primary surgical therapy is often avoided for soft palate squamous cell carcinoma (SCC) to prevent deleterious effects on speech and swallow function with locoregional flaps. Recently, early reports on speech and swallowing are favorable with the advent of free tissue reconstruction, which may expand the role of surgery for soft palate SCC. We aim to compare survival rates between upfront surgical and non-surgical pathways to determine the best treatment for patients in the era of free tissue transfer.

Methods: Patients from the National Cancer Database (NCDB) with soft palate SCC undergoing definitive treatment from 2004-2018 were analyzed. The primary outcome was overall survival based on primary surgery (+/- adjuvant treatment, PS) versus primary radiation (+/- chemotherapy, RT +/- C). Secondary outcomes were analyzed with multivariable Cox regression for proportional hazards.

Results: In total, 4,796 patients fit inclusion criteria (Figure 1) with a median age of 62 (IQR 55-70) and 68% male population. Baseline differences across PS and RT +/- C groups necessitated multivariable regression analysis (Table 2). Patients who underwent PS had lower T category tumors (85% T1/T2) compared to the RT +/- C group (58% T1/T2, p< 0.001).

Median survival time for patients undergoing PS was 69.7 months (95% CI 64.3-75.1) versus 47.9 months for RT +/- C (95% CI 44.9-50.7, p < 0.001). In subset analysis on T1 and T2 tumors alone, the observed benefit of PS over RT +/- C persisted (Figure 2C). Multivariable Cox proportional hazards survival analysis demonstrated that PS was associated with better overall survival (HR 0.78, 95% CI 0.7-0.87, Figure 3) compared to RT +/- C, which was also shown in subset analysis of T1/T2 tumors (HR 0.84, 95% CI 0.74-0.95)

Conclusions: In this NCDB study on soft palate SCC, PS conferred superior survival to RT +/- C based regimens. If emerging data continues to demonstrate favorable speech and swallow outcomes with free tissue transfer, this may support primary surgery as the treatment modality of choice for early-stage soft palate SCC.

Presenting Author(s)

NK

Nrusheel Kattar, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, LSU-Health Sciences Center, Shreveport, LA, USA
Shreveport, LA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Ivan A. Alvarez, BS

Medical Student
LSU Health Shreveport School of Medicine, Shreveport, LA, USA
Shreveport, Louisiana, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Victor H. Albornoz Alvarez, MD

Resident
Department of Otolaryngology-Head and Neck Surgery, LSU Health Shreveport, LA, USA
Shreveport, LA, United States

Disclosure information not submitted.
Farhoud Faraji, MD

Resident Physician
UC San Diego Department of Otolaryngology
La Jolla, CA, United States

Disclosure information not submitted.
SV

Srivatsa Surya Vasudevan, MD, MS

Research Associate
Department of Otolaryngology-Head and Neck Surgery, LSU Health Shreveport, LA, USA
Shreveport, LA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
LO

Lindsay Olinde, MD

Department of Otolaryngology-Head and Neck Surgery, LSU Health Shreveport, LA, USA, United States

Disclosure information not submitted.
Ameya A. Asarkar, MD

Assistant Professor
Department of Otolaryngology-Head and Neck Surgery, LSU Health Shreveport, LA, USA
Shreveport, Louisiana, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Cherie-Ann O. Nathan, MD

Professor and Chair of Otolaryngology - Head & Neck Surgery
LSU-Health Shreveport
Shreveport, Louisiana, United States

Disclosure information not submitted.

Senior Author(s)

John Pang, MD

Assistant Professor
LSU Health Shreveport
Shreveport, Louisiana, United States

Disclosure information not submitted.