Head and Neck Cancer

SS 31 - H&N 3 - Strategies to Improve Outcomes and Minimize Toxicity in Oropharyngeal Cancer

225 - Continued Improvement in Quality of Life (QoL) for Patients With Favorable Risk HPV-Associated Oropharyngeal Cancer > 1 Year After Completing De-Intensified Chemoradiotherapy

Tuesday, October 23
5:05 PM - 5:15 PM
Location: Room 214 A/B

Continued Improvement in Quality of Life (QoL) for Patients With Favorable Risk HPV-Associated Oropharyngeal Cancer > 1 Year After Completing De-Intensified Chemoradiotherapy
K. A. Pearlstein1, K. Wang1, R. J. Amdur2, J. Weiss1, J. Grilley-Olson1, A. Zanation1, T. Hackman1, B. Thorp1, J. Blumberg1, S. Patel1, N. C. Sheets1, M. Weissler1, W. M. Mendenhall2, and B. S. Chera3; 1University of North Carolina Hospitals, Chapel Hill, NC, 2Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, 3Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC

Purpose/Objective(s): We have previously shown that de-intensified chemoradiation (CRT) results in excellent cancer control. De-intensified CRT should also result in better recovery of QoL over time. We present 2 year QOL data for patients treated on two prospective multi-institutional de-intensified phase II clinical trials.

Materials/Methods: Major eligibility criteria for both studies (NCT01530997 and NCT02281955) were: 1) HPV or p16 positive oropharynx cancer 2) T0-3, N0-N2c, and 3) limited smoking history (≤ 10 pack years or ≤ 30 pack years with 5 years of abstinence). Treatment was 60Gy intensity modulated RT with concurrent weekly IV cisplatin (RT alone if T0-2 and N0-1). QoL (EORTC QLQ-C30 and H&N35) and dysphagia (EAT-10) surveys were completed at pre-treatment, end of treatment, and at 3-6 month intervals thereafter. Patients with ≥1 year of follow-up were included in this analysis. ≥10 point change from pre-treatment score was considered clinically meaningful (3 points for EAT-10). Logistic regression examined factors associated with return to pre-treatment levels at 1 and 2 years.

Results: 154 patients enrolled on the two studies, 139 completed follow-up surveys and 126 had at least 1 year of follow-up. Median follow-up was 25 months (65% with ≥2 years). 53% were ≥60 years old, 16% received unilateral RT, and 87% received concurrent chemo. For EORTC QLQ-C30 (Table), global QoL, functional domains, and individual symptoms returned to pre-treatment levels by one year post-RT and emotional domain was better than baseline. For the EORTC H&N35 (Table) all symptom items returned to pre-treatment levels except for xerostomia, sticky saliva, and senses (taste/smell) which continued to improve 2 years post-CRT. H&N35 swallowing and EAT-10 scores returned to pre-treatment levels by 12 months for the majority of patients. At 2 years, many patients returned to pre-treatment levels of dry mouth (21%), sticky saliva (54%), senses (32%), and EAT-10 score (62%). On multivariate analysis, return to pre-treatment sticky saliva score at 1 year was associated with higher baseline score (OR 1.02, 1.00-1.06) and unilateral neck RT (OR 3.4, 1.1-10.1). Return to baseline dysphagia score at 2 years was associated with higher baseline score (OR 1.1, 1.0-1.1), increasing age (OR 1.1, 1.0-1.2), and unilateral neck RT (OR 6.2, 1.1-33.3)

Conclusion: Among patients receiving de-intensified treatment on two prospective phase II trials, quality of life approaches pre-treatment levels by 1 year. Continued significant improvements in dry mouth and swallowing are seen through at least 2 years

Item

Baseline

6m

12m

24m

QLQC30 Global QOL*

81

75

82

84

QLQC30 Emotional QOL*

78

87

87

89

H&N35 Dry Mouth**

13

68

55

47

H&N35 Sticky Saliva**

8

44

35

27

H&N35 Senses**

6

31

24

20

H&N35 Swallowing**

8

15

11

10

EAT-10**

3.4

9.9

7.0

5.5

*Higher score better
**Lower score better

Author Disclosure: K.A. Pearlstein: Employee; University of North Carolina Hospitals. K. Wang: None. R.J. Amdur: Partnership; RadOnc eLearning Center, Inc. Head and Neck Oral Exam Director; ABR. RRC Member; ACGME. Editorial Board; AJCO, JCO, PRO. J. Weiss: None. J. Grilley-Olson: None. A. Zanation: None. T. Hackman: None. W.M. Mendenhall: Employee; University of Florida. B.S. Chera: Consultant; RO-HAC.

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225 - Continued Improvement in Quality of Life (QoL) for Patients With Favorable Risk HPV-Associated Oropharyngeal Cancer > 1 Year After Completing De-Intensified Chemoradiotherapy



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