Impact of Transoral Robotic Surgery Versus Radiation on Swallowing Function in Oropharyngeal Cancer Patients: A Sub-Study From a Randomized Trial

Julie A Theurer; Rosemary Martino; Nedeljko Jovanovic; John R de Almeida; David P Goldstein; Kevin Fung; John Yoo; S Danielle MacNeil; Eric Winquist; J Alex Hammond; Varagur Venkatesan; Nancy Read; Sarah Kuruvilla; Andrew Warner; Philip C Doyle; Ian Ross; Colleen Dreyer; Sarah Hawkins; Kendra Thouless; Courtney McCallum; David A Palma; Anthony C Nichols

doi:10.1002/hed.27986

Impact of Transoral Robotic Surgery Versus Radiation on Swallowing Function in Oropharyngeal Cancer Patients: A Sub-Study From a Randomized Trial

Head Neck. 2024 Nov 4. doi: 10.1002/hed.27986. Online ahead of print.

Authors

Julie A Theurer^{1

2

3}, Rosemary Martino^{2

4

5

6}, Nedeljko Jovanovic², John R de Almeida⁵, David P Goldstein⁵, Kevin Fung², John Yoo², S Danielle MacNeil², Eric Winquist⁷, J Alex Hammond⁸, Varagur Venkatesan⁸, Nancy Read⁸, Sarah Kuruvilla⁷, Andrew Warner⁸, Philip C Doyle⁹, Ian Ross¹⁰, Colleen Dreyer¹¹, Sarah Hawkins¹¹, Kendra Thouless¹¹, Courtney McCallum¹², David A Palma⁸, Anthony C Nichols²

Affiliations

¹ School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.
² Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada.
³ Lawson Health Research Institute, London, Ontario, Canada.
⁴ Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
⁷ Department of Medical Oncology, Western University, London, Ontario, Canada.
⁸ Divison of Radiation Oncology, Western University, London, Ontario, Canada.
⁹ Department of Otolaryngology - Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA.
¹⁰ Department of Radiology, Western University, London, Ontario, Canada.
¹¹ Department of Speech-Language Pathology, London Health Sciences Centre, London, Ontario, Canada.
¹² Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.

PMID: 39492633
DOI: 10.1002/hed.27986

Abstract

Background: This ORATOR sub-study evaluated swallowing physiology in patients treated with transoral robotic surgery (TORS) versus radiotherapy (RT) for early-stage oropharynx cancer.

Methods: Swallowing physiology was evaluated using videofluoroscopy and outcomes were compared across treatment arms and correlated with MDADI scores.

Results: Of the 68 patients in the ORATOR trial, 21 participated in this sub-study (30.8%), including 15 RT Arm and six TORS Arm patients. Swallowing profiles were not significantly different between the arms. MBSImP pharyngeal scores for RT Arm versus TORS Arm patients were 4.8 (±2.1) versus 4.3 (±1.5) at baseline, 6.2 (±1.2) versus 9.6 (±4.8) at 6 months and 5.9 (±1.8) versus 8.0 (±4.7) at 12 months. MBSImP pharyngeal scores demonstrated weak associations with several MDADI subscales and PAS scores.

Conclusions: To best describe swallowing outcomes in studies of RT and/or surgery, instrumental swallowing assessments should be strongly considered in addition to quality of life measures.

Keywords: ORATOR; oropharyngeal cancer; radiotherapy; swallowing physiology; transoral robotic surgery.

Grants and funding

Canadian Cancer Society Research Institute