In the original version of the Data Descriptor the surname of author Hesham Elhalawani was misspelled. This has now been corrected in the HTML and PDF versions.

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Purpose: The physical properties of proton therapy allow for decreased dose delivery to nontarget structures. The purpose of this study was to determine if this translates into a clinical benefit by comparing acute and chronic morbidity between patients with nasopharyngeal carcinoma who are treated with intensity-modulated proton therapy (IMPT) and those treated with intensity-modulated radiation therapy (IMRT). Materials and Methods: Patients receiving IMPT for nasopharyngeal cancer from 2011-13 were matched in a 2:1 IMPT to IMRT ratio. Matching criteria were, in order, T-stage, N-stage, radiation dose, chemotherapy type, World Health Organization classification, sex, and age. Results: Ten patients treated with IMPT and 20 matched patients treated with IMRT were included. By the end of treatment, 2 IMPT-treated patients (20%) and 13 IMRTtreated patients (65%) required gastrostomy tube (GT) insertion (P ¼ .020). Patients receiving IMPT had significantly lower mean doses to the oral cavity, brainstem, whole brain, and mandible. Increased mean dose to the oral cavity was associated with a higher rate of GT placement (P , .001), but mean dose to the brainstem, whole brain, and mandible was not. Partitioning analysis showed that no patient required GT insertion if the mean oral cavity dose was ,26 Gy, but all patients with a mean oral cavity dose. 41.8 Gy required GT insertion. Treatment type (IMPT versus IMRT), induction chemotherapy (yes versus no), mean oral cavity dose, mean brainstem dose, and mean mandible dose were entered into the multivariable model. Only higher mean oral cavity dose remained significantly associated with higher GT rates on multivariable analysis http://theijpt.org

for the MD Anderson Head and Neck Cancer Symptom Working Group IMPORTANCE A major goal of primary transoral robotic surgery (TORS) for oropharyngeal cancer is to optimize swallowing outcomes by personalized treatment based on pathologic staging. However, swallowing outcomes after TORS are uncertain, as are the outcomes compared with nonsurgical options. OBJECTIVES To estimate rates of acute dysphagia and recovery after TORS and to compare swallowing outcomes by primary treatment modality (TORS or radiotherapy). DESIGN, SETTING, AND PARTICIPANTSThis case series study was a secondary analysis of prospective registry data from 257 patients enrolled from March 1, 2015, to February 28, 2018, at a single academic institution who, according to the AJCC Staging Manual, 7th edition TNM classification, had low-to intermediate-risk human papillomavirus-related oropharyngeal squamous cell carcinoma possibly resectable by TORS. EXPOSURE Patients were stratified by primary treatment (75 underwent TORS and 182 received radiotherapy). MAIN OUTCOMES AND MEASURESModified barium swallow (MBS) studies graded per Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) and the MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) questionnaires were administered at standard intervals. Prevalence and severity of dysphagia were estimated per DIGEST before and after TORS and 3 to 6 months after treatment. Moderate-severe dysphagia (DIGEST grade Ն2) was assessed using logistic regression and compared by primary treatment group. The MDASI swallowing symptom severity item scores during and after radiotherapy were compared using generalized estimating equations by treatment status at the start of radiotherapy, after induction, and after TORS. RESULTS A total of 257 patients (mean [SD] age, 59.54 [9.07] years; 222 [86.4%] male) were included in the study. Dysphagia severity (per DIGEST) was significantly worse after TORS (r = −0.63; 95% CI, −0.78 to −0.44): 17 patients (22.7%; 95% CI, 13.8%-33.8%) had moderate-severe (DIGEST grade Ն2) acute post-TORS dysphagia significantly associated with primary tumor volume (odds ratio, 1.43; 95% CI, 1.11-1.84). DIGEST improved by 3 to 6 months but remained worse than that at baseline; at 3 to 6 months, the number of patients with DIGEST grade 2 or higher dysphagia was 5 (6.7%; 95% CI, 2.2%-14.9%) after primary TORS and 29 (15.9%; 95% CI, 10.9%-22.1%) after radiotherapy. At the start of radiotherapy, MDASI swallowing symptom severity item scores were significantly worse in the post-TORS group compared with postinduction (mean [SD] change, 2.6 [1.1]) and treatment-naive (mean [SD] change, 1.7 [0.3]) patients. This result inverted at radiotherapy end, and all groups converged at 3 to 6 months.CONCLUSIONS AND RELEVANCE Subacute swallowing outcomes were similar regardless of primary treatment modality among patients with low-to intermediate-risk oropharyngeal squamous cell carcinoma.

Objectives: We aim to report oncologic outcomes after conventional radiotherapy (ConRT) using opposed lateral beams and intensity-modulated radiation therapy (IMRT) for tumor (T)1 nodal (N)0 T1 N0 glottic squamous cell carcinoma.Study Design: Retrospective case-control study. Methods: We retrospectively reviewed demographic, disease, and treatment characteristics for patients treated at our institution during 2000 to 2013.Results: One hundred fifty-three patients (71%) were treated using ConRT and 62 (29%) using IMRT. The median follow-up for all patients was 68 months. There was no statistically significant difference in 5-year local control between patients with T1a versus T1b disease (94% vs. 89%, respectively, P = 0.5). Three-year locoregional control for patients treated with ConRT was 94% compared to 97% with IMRT (P = 0.4). Three-year overall survival (OS) for patients treated with ConRT was 92.5% compared with 100% with IMRT (P = 0.1). Twelve of 14 patients with local recurrence underwent salvage surgery with 5-year ultimate locoregional control of 98.5% and 97.1% in the ConRT and IMRT cohorts, respectively (P = 0.7). Multivariate analysis showed age < 60 years (P < 0.0001) and pretreatment Eastern Cooperative Oncology Group performance status <2 (P = 0.0022) to be independent correlates of improved OS. Postradiation cerebrovascular events were in four patients in the ConRT cohort (3%), whereas no patients in the IMRT cohort suffered any events.Conclusion: Because the oncologic outcomes for patients treated with IMRT were excellent and IMRT allows for carotid sparing, we have transitioned to IMRT as our standard for most patients with T1 glottic cancer.