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

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dc.citation.firstpage5088
dc.citation.issueNumber4
dc.citation.journalTitleCancer Medicine
dc.citation.lastpage5098
dc.citation.volumeNumber12
dc.contributor.authorHemmati, Mehdi
dc.contributor.authorBarbon, Carly
dc.contributor.authorMohamed, Abdallah S.R.
dc.contributor.authorvan Dijk, Lisanne V.
dc.contributor.authorMoreno, Amy C.
dc.contributor.authorGross, Neil D.
dc.contributor.authorGoepfert, Ryan P.
dc.contributor.authorLai, Stephen Y.
dc.contributor.authorHutcheson, Katherine A.
dc.contributor.authorSchaefer, Andrew J.
dc.contributor.authorFuller, Clifton D.
dc.date.accessioned2023-03-23T14:10:31Z
dc.date.available2023-03-23T14:10:31Z
dc.date.issued2023
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.
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.
dc.identifier.digital2022-Hemmati
dc.identifier.doihttps://doi.org/10.1002/cam4.5253
dc.identifier.urihttps://hdl.handle.net/1911/114521
dc.language.isoeng
dc.publisherWiley
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.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.titleOptimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on posttreatment swallowing toxicity
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpublisher version
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