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Scientific Oral Presentations (Best of Scientific Oral)

Head and Neck Surgery

Session: Best of Scientific Oral Presentations 2

Swallowing Outcomes of HPV+ OPSCC Survivors by POA(C)RT Dose in the MINT and E3311 Cohorts

Saturday, September 28, 2024
2:36 PM – 2:42 PM EDT
Location: MBCC, 222
Disclosure(s):
Theresa Tharakan, MD MSCI:

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

Wade L. Thorstad, MD:

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

Jose P. Zevallos, MD, MPH:

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

Sidharth V. Puram, MD, PhD:

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

Ryan S. Jackson, MD:

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

Introduction: De-intensified post-operative adjuvant (chemo)radiation therapy (POA(C)RT) for favorable-risk, human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a potential strategy to reduce treatment-related morbidities, such as dysphagia, in survivors. However, the effect of de-intensification on patient-reported outcomes of dysphagia has been mixed.

Methods: Retrospective analysis of prospective data for patients with locally advanced HPV+ OPSCC who underwent transoral robotic surgery followed by POA(C)RT in the Minimalist Trial (MINT) (single institution, 2018-2021) and E3311 (multicenter, 2014-2020). MINT patients in the intermediate-risk arm (T1-3, N0-2 disease with extranodal extension [ENE] or positive margins) received 42 Gy IMRT + 1 dose cisplatin 100 mg/m2 and in the low-risk arm (T1-3, N0-2 disease without ENE or positive margins) received 42 Gy IMRT alone. Intermediate-risk E3311 patients (T1-T2, < 3 mm margins, N1-2 with ≤1 mm ENE, ≤4 positive nodes) were randomized to receive 50 Gy or 60 Gy IMRT. Analysis was per-protocol by RT dose. Outcome was change in MD Anderson Dysphagia Inventory composite score (MDADI) from baseline to 1-year post-treatment. Within-patient change in MDADI was measured with a minimum clinically meaningful decline (CMD) of ≥10 points.

Results: 149 patients received POA(C)RT: n=26 at 42 Gy (n=18 no cisplatin, n=8 cisplatin), n=78 at 50 Gy, and n=45 at 60Gy. Mean (SD) change in MDADI from baseline to 1 year were similar across groups at -6.6 (10.1) in the 42 Gy arm, -10.9 (17.2) in the 50 Gy arm, and -8.8 (15.1) in the 60 Gy arm (ANOVA F=0.808, p=0.45). The rate of CMD in MDADI was 10/26 (39%) in the 42 Gy arm, 40/78 (51%) in the 50 Gy arm, and 19/45 (42%) in the 60 Gy arm (chi-square=1.7, p=0.42), without statistically significant pairwise differences in post-hoc analysis. The rate of CMD in MDADI was similar in those receiving 42 Gy with (3/8, 38%) and without cisplatin (7/18, 39%) (diff. 1%, 95% CI -64% to 67%).

Conclusions: Patients treated with POART doses in the range of 42-60Gy had similar patient-reported quality-of-life MDADI scores at 1-year after POA(C)RT.

    Presenting Author(s)

  • TT

    Theresa Tharakan, MD, MSCI

    Resident
    Washington University-B-JH/SLCH Consortium
    Saint Louis, Missouri, United States

    Disclosure(s):

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

    • Co-Author(s)

  • Wade L. Thorstad, MD

    Professor
    Washington University School of Medicine in St. Louis
    St. Louis, MO, United States

    Disclosure(s):

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

  • DA

    Douglas Adkins, MD

    Professor
    Washington University School of Medicine in St. Louis, United States

    Disclosure information not submitted.

  • Jose P. Zevallos, MD, MPH

    Professor & Chairman, Department of Otolaryngology The Eugene N. Myers, M.D., Professor and Chairman
    Department of Otolaryngology – Head and Neck Surgery, University of Pittsburgh, Medical Center
    Pittsburgh, PA, United States

    Disclosure(s):

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

  • Sidharth V. Puram, MD, PhD

    Chief of Head and Neck Surgery, Director of Rob Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman, Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

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

    • Senior Author(s)

  • RJ

    Ryan S. Jackson, MD

    Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

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