Amerongen, T. van (Tessa) (2021) Long-term oncologic and functional outcomes of primary transoral surgery versus primary radiotherapy for early-stage oropharyngeal squamous cell carcinoma A Retrospective Study of a Dutch Single Institution Cohort. thesis, Medicine.
Full text available on request.Abstract
Background: There is a rising incidence of human papillomavirus (HPV) related oropharyngeal squamous cell carcinomas (OPSCC) with better prognosis compared to HPV-negative tumors. As a result, side effects and functional outcomes of treatment are becoming more important. Previous studies suggest that transoral surgery retains the good prognosis of radiotherapy, but shows superior functional outcomes. However, more information is required. This study aims to compare the oncologic and functional outcomes between patients with early-stage OPSCC, undergoing radiotherapy or transoral surgery. Thereby, it provides insight into the short- and long-term side effects. Method: This is a retrospective cohort study performed in a tertiary referral hospital in the Netherlands. The primary outcomes were oncologic outcomes analyzed with the overall survival (OS), the disease-specific survival (DSS) and the disease-free interval (DFI). These outcomes were analyzed by the Kaplan-Meier method. A multivariable Cox regression was used to identify independent risk factors for survival. The secondary outcomes included the toxic effects, postoperative complications and swallowing outcomes. Results: The analyzed cohort consisted of 184 patients, 129 treated with radiotherapy and 55 treated with transoral surgery. The median follow-up time was 46 months. This study found similar DSS rates between the two treatment modalities. The OS an DFI seemed to be more favorable for patients treated with radiotherapy. Functional outcomes were equivalent after 1 year. No permanent or fatal complications were seen after transoral surgery. Xerostomia and taste disturbances were the most common and long-lasting radiation-induced toxic effects. Conclusion: The suggestion that transoral surgery has equal oncologic outcomes and/or better functional outcomes compared to radiotherapy cannot be supported by results of this study. Any treatment of early-stage OPSCC should be an individualized, tailored to the patient's preferences, multidisciplinary and shared decision. Ongoing prospective trials will provide more information about preserving survival while optimizing functional outcomes.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Schreuder, Drs. W.H. and Heirman, Drs. A.N. and Halmos, Dr. G.B. |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Dec 2021 10:16 |
| Last Modified: | 24 Dec 2021 10:16 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2907 |
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