Impact of post-chemoradiotherapy superselective/selective neck dissection on patient reported quality of life

Kyle Wang; Robert J Amdur; William M Mendenhall; Rebecca Green; Shannon Aumer; Trevor G Hackman; Adam M Zanation; Jose P Zevallos; Samip N Patel; Mark C Weissler; Bhishamjit S Chera

doi:10.1016/j.oraloncology.2016.04.015

Impact of post-chemoradiotherapy superselective/selective neck dissection on patient reported quality of life

Oral Oncol. 2016 Jul:58:21-6. doi: 10.1016/j.oraloncology.2016.04.015. Epub 2016 May 14.

Authors

Affiliations

¹ Department of Radiation Oncology, University of North Carolina Hospitals, 101 Manning Drive, CB #7512, Chapel Hill, NC 27599-7512, USA. Electronic address: [email protected].
² Department of Radiation Oncology, Health Science Center, University of Florida Hospitals, PO Box 100385, Gainesville, FL 32610-0385, USA. Electronic address: [email protected].
³ Department of Radiation Oncology, Health Science Center, University of Florida Hospitals, PO Box 100385, Gainesville, FL 32610-0385, USA. Electronic address: [email protected].
⁴ Department of Radiation Oncology, University of North Carolina Hospitals, 101 Manning Drive, CB #7512, Chapel Hill, NC 27599-7512, USA. Electronic address: [email protected].
⁵ Department of Radiation Oncology, University of North Carolina Hospitals, 101 Manning Drive, CB #7512, Chapel Hill, NC 27599-7512, USA. Electronic address: [email protected].
⁶ Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA. Electronic address: [email protected].
⁷ Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA. Electronic address: [email protected].
⁸ Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA. Electronic address: [email protected].
⁹ Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA. Electronic address: [email protected].
¹⁰ Department of Otolaryngology, Division of Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB #7070, Chapel Hill, NC 27599-7070, USA. Electronic address: [email protected].
¹¹ Department of Radiation Oncology, University of North Carolina Hospitals, 101 Manning Drive, CB #7512, Chapel Hill, NC 27599-7512, USA. Electronic address: [email protected].

PMID: 27311398
DOI: 10.1016/j.oraloncology.2016.04.015

Abstract

Objectives: To describe patient-reported quality of life (QoL) for patients with HPV/p16-positive oropharyngeal squamous cell carcinoma undergoing post-chemoradiation (CRT) superselective or selective neck dissection (ND) as part of a prospective de-intensification study.

Materials and methods: Patients received 60Gy IMRT with concurrent weekly cisplatin (30mg/m(2)), followed by preplanned neck dissection of only originally involved nodal levels. QoL measures were assessed using the EORTC QLQ-C30 (general), EORTC H&N-35 (head and neck specific), EAT-10 (swallowing), and NDII (Neck Dissection Impairment Index) questionnaires. Early and late post-ND time points were compared to baseline and post-CRT/pre-ND time points.

Results: 37 patients underwent post-CRT superselective or selective ND. Median # of levels and nodes dissected were 2 and 12, respectively. EORTC QLQ-C30, H&N-35, and EAT-10 QoL scores worsened after CRT but continued to improve thereafter despite post-CRT ND. NDII score worsened initially after ND at the early post-ND time point (p=0.023) but had recovered by the late post-ND time point (p=0.672). Initial decrease in NDII was greater with ⩾12 nodes dissected (p=0.007) and was correlated with the total number of nodes dissected (Spearman p=0.027).

Conclusion: Use of post-CRT superselective and selective ND did not prevent recovery of most QoL metrics to near baseline. There was early but not late decrement in neck dissection specific QoL (NDII), more pronounced with more nodes dissected.

Keywords: Chemoradiation; De-intensification; HPV; Neck dissection; Oropharynx cancer; Quality of life; Selective; Squamous cell carcinoma; Superselective.

MeSH terms

Carcinoma, Squamous Cell / therapy*
Carcinoma, Squamous Cell / virology
Chemoradiotherapy
Head and Neck Neoplasms / therapy*
Head and Neck Neoplasms / virology
Humans
Neck Dissection*
Papillomaviridae
Prospective Studies
Quality of Life*
Treatment Outcome