Treatment modality impact on quality of life for human papillomavirus-associated oropharynx cancer.

OBJECTIVES/HYPOTHESIS: Compare treatment-related quality of life (QOL) impact for early-stage human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+ OPSCC) patients. STUDY DESIGN: Retrospective cohort at a tertiary center. METHODS: Stage I (T0-2/N0-1) HPV+ OPSCC patients (n = 76) with pretreatment Karnofsky scores ≥80 reported QOL after surgery alone (n = 17, 22%), surgery with adjuvant radiation ± chemotherapy (S-a[C]XRT) (n = 23, 30%), or definitive radiation ± chemotherapy (d[C]XRT) (n = 36, 47%) with the University of Washington QOL version 4 (UW-QOL); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ-C30) and Head and Neck Module (EORTC QLQ-HN35); University of Michigan Xerostomia, and Neck Dissection Impairment Index questionnaires (median follow-up = 2.2 years, interquartile range = 1.0-4.2 years). Treatment adverse events and gastrostomy tube rates were assessed. RESULTS: Over 87% of each treatment group reported good or better overall QOL. Each group had low gastrostomy tube and treatment-specific complication rates. S-a(C)XRT and d(C)XRT patients had similar mean scores with wide ranges for most individual and all composite categories. S-a(C)XRT compared to d(C)XRT patients reported significantly fewer dental problems (EORTC QLQ-C30/HN35 means = 10.1 vs. 34.3, P = .007), worse appearance (UW-QOL means = 72.8 vs. 82.6, P = .02), and worse coughing (EORTC QLQ-C30/HN35 means = 31.9 vs. 15.7, P = .007). Surgery alone compared to d(C)XRT and S-a(C)XRT patients reported significantly better salivary/taste/oral functions and less pain, financial, oral/dental, and sexual problems. CONCLUSIONS: For early-stage HPV+ OPSCC, patients usually achieve acceptable QOL regardless of treatment. S-a(C)XRT and d(C)XRT patients report generally similar QOL including neck/shoulder pain/function, but with a wide range in a limited patient sample. Surgery alone should be considered, when oncologically and functionally safe, given the better associated QOL. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E48-E56, 2020.

One-Year symptom outcomes after sialolithiasis treatment with sialendoscopy-assisted salivary duct surgery.

OBJECTIVES: For chronic obstructive sialadenitis, there is a paucity of long-term prospective evidence of disease-specific symptom outcomes after sialendoscopy-assisted salivary duct surgery (SASDS). We prospectively assessed patients with sialolithiasis before and at 3 months and 1 year after SASDS using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire. METHODS: A prospective cohort study of adult patients with sialolithiasis who underwent SASDS and completed the COSS questionnaire over a 1-year follow-up period. The COSS questionnaire consists of 20 disease-specific symptom questions. COSS score outcomes were classified by complete, partial, and nonresolution, as well as by clinically significant improvement. RESULTS: Ninety-six patients underwent SASDS in 110 glands, of which 69 glands (63%) had findings of sialolithiasis. The following median COSS scores were reported for sialolithiasis glands: preoperative, 27.5 (interquartile range [IQR]: 12.5-44); 3 months, 1 (IQR: 0-5); and 1 year, 1 (IQR: 0-5.5). Patients with sialolithiasis reported statistically significant improvements in COSS scores from preoperative to 3 months post-SASDS (P > 0.05). A vast majority of patients maintained this improvement from 3 months to 1 year, indicating durability. Complete resolution of symptoms was attained in 95% and 85% of glands at 3 months and 1 year, respectively. Open/hybrid compared to endoscopic-only sialolithiasis extraction achieved similar 3-month and 1-year COSS outcomes. Potential risk factors for symptom persistence after SASDS included nonreachable parenchymal sialoliths and concurrent inflammatory disease and/or stenosis. CONCLUSION: SASDS for sialolithiasis extraction is associated with durable, long-term benefit regardless of endoscopic or open technique or sialolith location, suggesting that subsequent ductal stenosis from iatrogenic or sialolithiasis-related inflammation fibrosis is unlikely. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:396-402, 2019.

One-year outcomes of sialendoscopic-assisted salivary duct surgery for sialadenitis without sialolithiasis.

OBJECTIVES: To prospectively examine durability of long-term outcomes in sialendoscopy-assisted salivary duct surgery (SASDS) in chronic obstructive sialadenitis without sialolithiasis (COSWS). METHODS: A prospective cohort study of adult patients with COSWS who completed Chronic Obstructive Sialadenitis Symptoms (COSS) Questionnaire prior to and at 3 months and 1 year following SASDS. COSS scores scaled to 0 to 100 were analyzed by statistically significant improvements and previously published ranges corresponding to complete, partial, and nonresolution of symptoms. RESULTS: Twenty-nine patients with COSWS affecting 41 glands had statistically significant improvements in COSS scores at 3 months following SASDS. These improvements usually were sustained at 1 year, supporting durability of treatment effect over time. A majority of cases (30 of 41, 73%) achieved at least a partial resolution of sialadenitis symptoms (COSS score ≤ 25) at 1-year follow-up. Symptom improvement after SASDS was noted in 14 of 18 (78%) glands with radioiodine-induced sialadenitis (RAI-IS). The highest proportion of persistent or recurrent disease at 1-year post-SASDS was found in autoimmune sialadenitis (2 of 4, 50%) and glands with proximal or multifocal stenoses (6 of 12, 50%). At 1 year, distal duct stenoses achieved a significantly higher proportion of partial or complete symptom resolution (18 of 21, 86%) than cases with proximal or multifocal stenoses (6 of 12, 50%; P = 0.044). CONCLUSIONS: SASDS is effective in reducing symptoms in duct stenosis and RAI-IS, usually with durable treatment benefits at long-term follow-up. Distal stenoses appear to be more amenable to sialendoscopic treatment, achieving greater symptom reduction than proximal/multifocal stenoses. Additional larger multi-center studies are needed to further characterize risk factors for COSWS refractory to SASDS. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:890-896, 2019.