title: Comparisons of dysphagia and quality of life (QOL) in comparable patients with HPV-positive oropharyngeal cancer receiving chemo-irradiation or cetuximab-irradiation.
abstract: OBJECTIVE
  Compare functional outcomes of radiotherapy (RT) concurrent with cetuximab (cet-RT) or with chemotherapy (chemo-RT) for comparable, good prognosis patients with human papillomavirus related (HPV+) oropharyngeal cancer (OPC).
  
  
  METHODS
  Outcomes of patients with stage III/IV HPV+ OPC patients with minimal smoking history and non-T4/N3/N2C, treated on prospective protocol of RT concurrent with cetuximab (cet-RT), were compared to similar patients on prospective chemo-RT protocols. In both groups, videofluoroscopy (VF), observer rated dysphagia (ORD), and validated QOL questionnaires: xerostomia questionnaire (XQ), head and neck QOL, and University of Washington QOL, were performed periodically and compared to pretreatment. Mixed effects models with adjustment for baseline assessed differences between groups.
  
  
  RESULTS
  26 cet-RT patients were compared to 27 chemo-RT patients with similar baseline characteristics. In the chemo-RT group, no recurrences occurred. In the cet-RT group, 1 patient had persistent microscopic disease on salvage neck dissection and 1 distant failure. Both groups had mild VF-based swallowing dysfunction pre-treatment, worsened at 3 months (P<0.02) and persisted at 12 months, not differing between groups (P>0.11). For both groups ORD was very low pretreatment, worsened at 3 months and improved at 12 months, without differences between treatment groups (P=0.26). QOL Summary and domain scores for eating were good pretreatment, worse at 3 mo, and then improved to near baseline at 12 months, without differences between the groups in any QOL domains (P>0.10).
  
  
  CONCLUSIONS
  Both groups had excellent clinical outcomes without significant differences in objective or subjective functions. These data question using cetuximab instead of chemotherapy for treatment de-intensification for HPV+ OPC.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Samuels
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Yebin
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Teresa
authors.initials: T
authors.lastname: Lyden
authors.affiliation: Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Marc
authors.initials: M
authors.lastname: Haxer
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Spector
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Malloy
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Medicine - Medical Oncology Division, University of Michigan, United States.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.affiliation: Department of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Schipper
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States. Electronic address: eisbruch@umich.edu.
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068818:Cetuximab / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068818:Cetuximab
keywords: Cetuximab; Chemo-RT; Oropharyngeal cancer; Quality of life; Swallowing