Head and Neck Cancers Coverage from Every Angle
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Radiotherapy Versus Surgery in Oropharyngeal Cancer: Quality of Life From ORATOR Trial

By: Joseph Fanelli
Posted: Thursday, September 5, 2019

According to results from the phase II ORATOR trial presented in The Lancet Oncology comparing radiotherapy and transoral robotic surgery plus neck dissection for patients with oropharyngeal squamous cell carcinoma, those who received radiotherapy demonstrated better swallowing-related quality-of-life scores after 1 year of treatment. Anthony C. Nichols, MD, of the London Health Sciences Centre, Ontario, Canada, and colleagues noted that although the difference in swallowing outcomes did not represent a clinically relevant margin, they conflicted with previous retrospective data and should be considered when making treatment decisions for these patients.

“The clinically similar [quality-of-life] outcomes and differing spectra of toxicities indicate that clinicians and patients should be involved in shared decision-making, in a multidisciplinary context, to individualize treatment for [oropharyngeal squamous cell carcinoma],” the authors concluded.

This multicenter, international, open-label study was reportedly the first randomized trial to compare radiotherapy with transoral robotic surgery plus neck dissection. The investigators enrolled 68 patients with oropharyngeal squamous cell carcinoma (Eastern Cooperative Oncology Group scores of 0 to 2) from six hospitals in Canada and Australia. The patients were assigned 70 Gy of radiotherapy (34 patients) or transoral robotic surgery plus neck dissection (34 patients).

The authors found that the MD Anderson Dysphagia Inventory scores after 1 year were better in the radiotherapy cohort than in the transoral robotic surgery group (86.9 vs. 80.1, respectively). The authors noted that although the difference in scores was relevant, a margin of 10 points is considered a “clinically meaningful change.”

Patients who received radiotherapy reported more cases of neutropenia (6 patients), hearing loss (13 patients), and tinnitus (12 patients) than those who had surgery. Patients in the latter cohort reported more cases of trismus (9 patients). The most common adverse events for those treated with radiotherapy were dysphagia (6 patients), hearing loss (6 patients), and mucositis (4 patients), whereas those who had surgery most often experienced dysphagia (9 patients), with one death from bleeding after surgery.

Disclosure: The study authors’ disclosure information may be found at thelancet.com.

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