Patient-Reported Swallowing Outcomes in HPV+ Oropharyngeal Cancer by Postoperative Chemoradiation Dose in MINT and E3311.

Abstract

Evaluate the effect of deintensified postoperative adjuvant (chemo)radiation therapy (POA(C)RT) on patient-reported dysphagia outcomes in patients with human papillomavirus (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Retrospective. Multiple institutions, 2014 to 2021. Patients with HPV+ OPSCC underwent transoral robotic surgery and reduced-dose POA(C)RT by pathologic risk stratification. The Minimalist Trial (MINT) participants received 42 Gy radiation therapy (RT) with one dose of cisplatin 100 mg/m² (intermediate-risk arm) or no cisplatin (low-risk arm). The intermediate-risk E3311 participants were randomized to 50 or 60 Gy RT. Analysis was per-protocol by RT dose group. The primary outcome was change in MD Anderson Dysphagia Inventory (MDADI) composite score from baseline to 1-year posttreatment, with a clinically meaningful decline (CMD) of ≥10 points. In total, 156 included patients received POA(C)RT: n = 28 at 42 to 49 Gy (n = 19 no cisplatin, n = 9 cisplatin), n = 82 at 50 to 59, and n = 46 at 60 Gy. Mean (SD) change in MDADI was -7.2 (10.6) in the 42 to 49 Gy group, -11.3 (17.2) in the 50 to 59 group, and -9.1 (15.1) in the 60 Gy group (analysis of variance [ANOVA] P = .46). The rate of CMD was 11/28 (39%) in the 42 to 49 Gy group, 43/82 (52%) in the 50 to 59 group, and 20/46 (44%) in the 60 Gy group (chi-square P = .42). The rate of CMD was similar in those receiving 42 to 49 Gy with (3/9, 33%) and without cisplatin (8/19, 42%) (diff. 1%, 95% CI -29% to 47%). Gastrostomy tube rates were similar across dose groups. Changes in dysphagia-related quality-of-life (MDADI) from baseline to 1 year after POA(C)RT did not differ by radiation dose in the range of 42 to 60 Gy.