Optimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on posttreatment swallowing toxicity

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dc.citation.firstpage5088en_US
dc.citation.issueNumber4en_US
dc.citation.journalTitleCancer Medicineen_US
dc.citation.lastpage5098en_US
dc.citation.volumeNumber12en_US
dc.contributor.authorHemmati, Mehdien_US
dc.contributor.authorBarbon, Carlyen_US
dc.contributor.authorMohamed, Abdallah S.R.en_US
dc.contributor.authorvan Dijk, Lisanne V.en_US
dc.contributor.authorMoreno, Amy C.en_US
dc.contributor.authorGross, Neil D.en_US
dc.contributor.authorGoepfert, Ryan P.en_US
dc.contributor.authorLai, Stephen Y.en_US
dc.contributor.authorHutcheson, Katherine A.en_US
dc.contributor.authorSchaefer, Andrew J.en_US
dc.contributor.authorFuller, Clifton D.en_US
dc.date.accessioned2023-03-23T14:10:31Zen_US
dc.date.available2023-03-23T14:10:31Zen_US
dc.date.issued2023en_US
dc.description.abstractBackground A primary goal in transoral robotic surgery (TORS) for oropharyngeal squamous cell cancer (OPSCC) survivors is to optimize swallowing function. However, the uncertainty in the outcomes of TORS including postoperative residual positive margin (PM) and extranodal extension (ENE), may necessitate adjuvant therapy, which may cause significant swallowing toxicity to survivors. Methods A secondary analysis was performed on a prospective registry data with low- to intermediate-risk human papillomavirus–related OPSCC possibly resectable by TORS. Decision trees were developed to model the uncertainties in TORS compared with definitive radiation therapy (RT) and chemoradiation therapy (CRT). Swallowing toxicities were measured by Dynamic Imaging Grade of Swallowing Toxicity (DIGEST), MD Anderson Dysphagia Inventory (MDADI), and the MD Anderson Symptom Inventory–Head and Neck (MDASI-HN) instruments. The likelihoods of PM/ENE were varied to determine the thresholds within which each therapy remains optimal. Results Compared with RT, TORS resulted in inferior swallowing function for moderate likelihoods of PM/ENE (>60% in short term for all instruments, >75% in long term for DIGEST and MDASI) leaving RT as the optimal treatment. Compared with CRT, TORS remained the optimal therapy based on MDADI and MDASI but showed inferior swallowing outcomes based on DIGEST for moderate-to-high likelihoods of PM/ENE (>75% for short-term and >40% for long-term outcomes). Conclusion In the absence of reliable estimation of postoperative PM/ENE concurrent with significant postoperative PM, the overall toxicity level in OPSCC patients undergoing TORS with adjuvant therapy may become more severe compared with patients receiving nonsurgical treatments thus advocating definitive (C)RT protocols.en_US
dc.identifier.citationHemmati, Mehdi, Barbon, Carly, Mohamed, Abdallah S.R., et al.. "Optimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on posttreatment swallowing toxicity." <i>Cancer Medicine,</i> 12, no. 4 (2023) Wiley: 5088-5098. https://doi.org/10.1002/cam4.5253.en_US
dc.identifier.digital2022-Hemmatien_US
dc.identifier.doihttps://doi.org/10.1002/cam4.5253en_US
dc.identifier.urihttps://hdl.handle.net/1911/114521en_US
dc.language.isoengen_US
dc.publisherWileyen_US
dc.rightsThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_US
dc.titleOptimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on posttreatment swallowing toxicityen_US
dc.typeJournal articleen_US
dc.type.dcmiTexten_US
dc.type.publicationpublisher versionen_US
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