title: Favorable patient reported outcomes following IMRT for early carcinomas of the tonsillar fossa: Results from a symptom assessment study.
abstract: BACKGROUND
  A questionnaire-based study was conducted to assess long-term patient reported outcomes (PROs) following definitive IMRT-based treatment for early stage carcinomas of the tonsillar fossa.
  
  
  METHODS
  Participants had received IMRT with or without systemic therapy for squamous carcinoma of the tonsillar fossa (T1-2 and N0-2b) with a minimum follow-up of 2years. Patients completed a validated head and neck cancer-specific PRO instrument, the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Symptoms were compared between treatment groups of interest and overall symptom burden was evaluated.
  
  
  RESULTS
  Of 139 participants analyzed, 51% had received ipsilateral neck IMRT, and 62% single modality IMRT alone (no systemic therapy). There were no differences in mean severity ratings for the top-ranked individual symptoms or symptom interference for those treated with bilateral versus ipsilateral neck IMRT alone. However, 40% of those treated with bilateral versus 25% of those treated with ipsilateral neck RT alone reported moderate-to-severe levels of dry mouth (p=0.03). Fatigue, numbness/tingling, and constipation were rated more severe for those who had received systemic therapy (p<0.05 for each), but absolute differences were small. Overall, 51% had no more than mild symptom ratings across all 22 symptoms assessed.
  
  
  CONCLUSIONS
  The long-term patient reported symptom profile in this cohort of tonsil cancer survivors treated with definitive IMRT-based treatment showed a majority of patients with no more than mild symptoms, low symptom interference, and provides an opportunity for future comparison studies with other treatment approaches.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: gbgunn@mdanderson.org.
authors.forename: G Brandon
authors.initials: GB
authors.lastname: Gunn
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Texas Tech University Health Sciences Center, School of Medicine, Lubbock, USA.
authors.forename: Chase C
authors.initials: CC
authors.lastname: Hansen
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Medical Physics Program, The University of Texas Graduate School of Biomedical Sciences, Houston, USA.
authors.forename: Clifton D
authors.initials: CD
authors.lastname: Fuller
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology, University of Alexandria, Egypt.
authors.forename: Abdallah S R
authors.initials: AS
authors.lastname: Mohamed
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Chronowski
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Lewis
authors.affiliation: Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Kate A
authors.initials: KA
authors.lastname: Hutcheson
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.affiliation: Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000532:radiotherapy*; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D017741:Survivors; D063189:Symptom Assessment; D014067:Tonsillar Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D014987:Xerostomia / Q000209:etiology
keywords: IMRT; Patient reported outcomes; Symptoms; Tonsil cancer