Chemoradiotherapy for SCCHN: Favorable Oncologic, Long-Term Functional Outcomes
The single-arm phase 2 trial evaluated long-term functional outcomes after induction chemotherapy of 6 weekly cycles of paclitaxel, carboplatin, and cetuximab followed by risk-based local therapy—single modality radiation, concurrent chemoradiation, or surgery with adjuvant radiotherapy—determined on the basis of disease site and stage at diagnosis in 47 patients with previously untreated stage IV SCCHN, noted Katherine A. Hutcheson, PhD, of the University of Texas MD Anderson Cancer Center, Houston, TX.
Median age was 53 years; 31 patients were male and most had oropharyngeal tumors (41/47, 87.2%); 63.8% (30/47) had T1 or T2 tumors and all were nodal-classification ≥N2b. A total of 23 patients (48.9%) received single modality radiation, 22 (46.8%) received concurrent chemoradiation, and 2 (4.6%) received surgery with adjuvant radiotherapy.
Baseline and 24-month functional assessments included modified barium swallow (MBS) studies, the Performance Status Scale-Head and Neck (PSS-HN), and the MD Anderson Dysphagia Inventory (MDADI). “MBS studies were analyzed using Oropharyngeal Swallow Efficiency (OPSE). Final diet level, gastrostomy dependence, tracheostomy dependence, and laryngectomy status were recorded a minimum of 5 years after enrollment,” she reported.
The 5-year overall survival rate was 89% (95% CI: 81%–99%); no tumor recurred in the 12 patients known to be HPV-positive.
A nonsignificant 13% average reduction in swallowing efficiency on MBS studies was found across all consistencies at 24-months relative to baseline (P=0.191); only pudding OPSE scores were significantly lower at 24 months (P=0.035). Mean composite MDADI scores approximated baseline values at 24-months (P=0.127), but 24-month physical subscale MDADI scores were significantly lower than baseline (P=0.005).
Final functional outcomes were evaluable in 42 long-term survivors at a median follow-up of 5.9 years. “Overall, 3 (7.1%) long-term survivors had chronic dysphagia, 2 of whom had baseline dysphagia per MBS studies. The rate of final gastrostomy dependence was 4.8% (2/42) and 90.5% (38/42) tolerated a soft or regular oral diet. No patient required permanent tracheostomy,” Dr. Hutcheson said.
They found 2 patients with chronic aspiration on MBS studies had recurrent pneumonias more than 12 months following treatment: 1 had a significant baseline tumor-related dysphagia and 1 developed progressive pharyngeal dysphagia in the first year of follow-up. “Two patients (4.2%) developed stricture, both managed successfully with dilation within the first year of treatment. No cases of late-onset dysphagia or stricture were observed at last follow-up,” they concluded, adding that “overall MBS and MDADI evaluations found only modest changes in swallowing function at 2 years, and chronic aspiration and pneumonia were rare sequelae (<5%) in long-term survivors.”