No abstract

Human Papilloma Virus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is rapidly becoming the most commonly diagnosed head and neck malignancy [1,2] and its prevalence is expected to continue to increase in the coming years [3,4]. While oropharyngeal cancers have traditionally been treated with radiation therapy, chemoradiation therapy and open surgical treatments including labiotomy and mandibulectomy [5-8], these treatment options often lead to significant functional sequelae that may be long-term [9-13]. Transoral robotic surgery (TORS) is rapidly gaining momentum as a minimally invasive treatment option for a select patient population as it has been shown to provide sufficient control of oncologic disease [14,15] with superior functional outcomes [16-22]. The advent of TORS technology is particularly important for patients diagnosed with HPV-related OPSCC. HPV-related OPSCC patients are often younger with longer overall life expectancies [23,24]; therefore, avoiding long-term sequelae of therapy has become an important issue in this patient population [25]. Although favorable swallowing outcomes have been reported following single modality treatment with TORS [26], research has shown that many patients require post-operative adjuvant radiation or chemoradiation due to unforeseen negative prognostic factors discovered in their resected tumor or neck specimen [27]. These adjuvant treatments are thought to further impact acute and late toxicities, can result in fibrosis and scarring, and ultimately have negative effects on swallowing safety and efficiency [25,28]. Several studies have investigated swallowing function after TORS with methods involving patient-reported quality of life and function [16,29]. In a systematic review of a MEDLINE database, Hutcheson et al. found that feeding tube rates were the most commonly reported measure to assess functional outcome [30]; however, there is a clear lack of published studies utilizing standardized measures to assess functional outcomes and oral intake ability in these patients. The functional oral intake scale (FOIS) is a standardized subjective dietary scale originally validated in stroke patients to assess functional outcomes through a patient's oral intake over time [31]. It has previously been used to assess swallowing and oral intake function in head and neck cancer patients in the pre-treatment period [32] as well as in the post-operative period in head and neck squamous cell carcinoma TORS patients [33]. FOIS is a clinician-rated scale based on a patient's report of oral intake and provides clinicians a better understanding of a patient's functional ability [31]. The purpose of this retrospective study was to assess the impact of three treatment sequences [TORS alone, TORS followed by radiation (RT), and TORS followed by chemoradiation (CRT)] on the short (3 and 6 months) and longterm (12 months) functional outcome of oral intake in patients with HPV-related OPSCC using the FOIS. We hypothesized that patients undergoing triple therapy (TORS followe...