Prospective Evaluation of Oral Cavity Dosimetric Parameters as Predictors of Quality of Life Outcomes in Patients Undergoing Chemoradiation for Locally Advanced Oropharyngeal Squamous Cell Carcinoma

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Cancer Clin Trials

Abstract

Background: Concurrent chemoradiation (chemoRT) for oropharyngeal squamous cell carcinoma (OPSCC) has improved survival; however, this intensive treatment comes at the expense of increased toxicity and worse quality of life (QOL). Data from a prospective randomized trial was used to assess the impact of oral cavity (OC) dose on QOL outcomes. Objectives: Based off this prospective data, we would like to report on the association between OC dose and quality of life outcomes. Methods: All patients (n=56) had AJCC 7th ed stage III-IV OPSCC and underwent concurrent chemoRT. RT dose was 70 Gy in 35 fractions using a VMAT technique. To assess QOL, patients completed the Patient-Reported Oral Mucositis Symptom (PROMS) scale at baseline, weekly during treatment, and at 6-week follow-up (higher scores indicate worse QOL). The OC was contoured using consensus guidelines (Brouwer, et al Radiother Oncol 2015). For dosimetric data, we collected OC max and mean doses (Gy) and volume (%) receiving x Gy (Vx) in 10 Gy increments. PROMS scores at week 7 (end of treatment) and follow-up timepoints were used for analysis. In addition to the total PROMS score, we analyzed question 1 individually (PROMS1-mouth pain) and questions 4, 5, 6, and 9 combined (PROMS4569-difficulty eating and swallowing). PROMS scores were dichotomized at the median to create two comparison groups, and dosimetric differences were assessed using Wilcoxon-rank sum tests (P< 0.05 considered significant). Results: At the week 7 endpoint, there were no differences noted in OC doses when the total PROMS score was dichotomized at the median. For PROMS1, there were significant dosimetric differences noted in OC mean dose (56.8 Gy vs 62.2 Gy, P= 0.04) and V50 (64.7% vs 81.5%, P= 0.05) in the low and high score arms, respectively. Additionally, differences in OC V40 (84.8% vs 92.7%, P=0.08), V60 (48.6% vs 71.2%, P= 0.05), and V70 (28.4% vs 40.4%, P=0.06) trended towards significance in the low and high score arms, respectively. For PROMS4569, there were no significant differences noted in the dosimetric parameters. At follow-up examining total PROMS score, there was a significant difference in OC V70 (25.6% vs 38.2%, P=0.05) in the low and high score arms, respectively. Additionally, OC V60 (47.8% vs 61.1%, P= 0.09) trended towards significance in the low and high score arms, respectively. For PROMS1 at follow-up, there were no significant differences noted in the dosimetric parameters. There were also no significant findings for PROMS4569 at follow-up; however, OC V70 (27% vs 38.2%, P= 0.09) trended towards significance in the low and high score arms, respectively. Conclusions: We found that patients who had worse QOL scores at the end of treatment, especially related to mouth pain, had significantly higher OC mean and V50 dosimetric parameters. Additionally, higher OC V60 and V70 parameters may predict for longer term detriment to QOL. These variables should be optimized during treatment planning to improve outcomes.

Volume

44

Issue

10

First Page

S79

Last Page

S80

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