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Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer §

Authors

  • Jason T. Rich MD,

    1. Department of Otolaryngology—Head and Neck Surgery , Washington University School of Medicine, St. Louis, Missouri, U.S.A.
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  • Jingxia Liu PhD,

    1. Division of Biostatistics , Washington University School of Medicine, St. Louis, Missouri, U.S.A.
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  • Bruce H. Haughey MBChB

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery , Washington University School of Medicine, St. Louis, Missouri, U.S.A.
    • Head and Neck Surgical Oncology Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8115, St. Louis, MO 63110
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  • Presented at the 2010 Annual Meeting at the Combined Otolaryngology Spring Meetings of the Triological Society, Las Vegas, Nevada, U.S.A., April 28–May 2, 2010.

  • The funding for this article was provided through private patient donation, Kathryn Trinkaus of the Biostatistics Core, Siteman Comprehensive Cancer Center, and NCI Cancer Center Support Grant P30 CA091842.

  • §

    The authors have no conflicts of interests to declare.

  • The authors have no financial disclosures for this article.

Abstract

Objectives/Hypothesis:

To perform a longitudinal description of swallowing function following transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer (OPC) and identify prognostic factors associated with swallowing performance.

Study Design:

Retrospective analysis and longitudinal descriptive study of swallowing outcomes.

Methods:

Patients treated with TLM for AJCC stage III–IV OPC at Washington University from 1996 to 2008 were included. A search of medical records and direct patient contact were performed to obtain swallowing function at multiple time points. Persistently poor swallowing at 2 year after surgery was the primary outcome measure. Two year swallowing outcomes stratified by tumor site and T stage are presented.

Results:

One hundred eighteen patients met criteria for the study (median follow-up 53.9 months). There were 44 T1's, 41 T2's, 23 T3's and 10 T4's. Forty seven percent received radiotherapy and 41% received chemoradiotherapy. Ninety-eight percent underwent neck dissection. Patients tolerated TLM well with 82% enjoying good swallowing at 1 month after surgery. During adjuvant therapy, at 3 months, good swallowing dropped to 55%. At 1 and 2 years after TLM, 89% and 88% of patients had good swallowing function, respectively. At 2 years, 9 patients had persistently poor swallowing function. 93% of patients with T1 through T3 enjoyed good swallowing at 2 years. T4 base of tongue disease was associated with persistently poor swallowing function in multivariate analyses (P = 0.0023), with 40% having good swallowing at 2 years. Preexisting comorbidities and conversion to an open procedure were associated with delayed return of swallowing function, but not with persistently poor swallowing. Seven patients developed late-onset swallowing dysfunction.

Conclusions:

Treatment of advanced stage OPC with TLM ± adjuvant therapy results in excellent swallowing outcomes for patients with either T1 to T3 tonsil or T1 to T3 base of tongue resections. A detailed, longitudinal swallowing profile is presented to assist in preoperative counseling.

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