(P074) Patient-Reported Quality of Life Outcomes After De-Escalated Chemoradiation for HPV-Positive Oropharyngeal Carcinoma: Findings From a Phase II Trial

Abstract

We report on patient-reported quality of life (QOL) outcomes from a phase II multi-center trial of induction chemotherapy followed by response-adapted, dose-reduced chemoradiation for locally-advanced human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC). Eligibility included newly-diagnosed, biopsy-proven stage III or IV oropharyngeal SCC, p16-positivity, age > 18 years, and Zubrod performance status 0-1. Treatment was induction paclitaxel 175 mg/m2 and carboplatin AUC 6 for two cycles every 21 days followed by concurrent paclitaxel 30 mg/m2 every 7 days with response-adapted, dose-reduced radiation of 54 Gy or 60 Gy. The University of Washington Quality of Life (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaires were used to assess patient-reported QOL outcomes. A t-test statistic was used to compare QOL scores following treatment to baseline scores. Forty-five patients were enrolled, of whom 40 completed QOL surveys and were evaluable. 25.0% had T3-T4 tumors, and 20.0% had N2c-N3 nodal disease. 77.5% had < 10 pack-year smoking history, and 72.5% had < moderate alcohol use. For the UW-QOL survey, speech-and-swallow-related outcomes showed recovery to baseline levels by 6-9 months following treatment except for swallowing, taste, and saliva, which improved more slowly. For other QOL-related metrics, recovery was seen by 6 months, with continued improvement even at 24 months. The (median) overall UW-QOL score returned to baseline levels at 9 months (p=0.51). For the FACT-H&N questionnaire, overall scores reached nadir at 4 weeks following treatment and recovered by 6 months (p=0.51). Dose de-escalated chemoradiation for HPV-associated, locally-advanced oropharyngeal SCC resulted in favorable patient-reported QOL outcomes, with continued improvement in salivary, taste, and swallowing function into the second year after treatment. These results serve as powerful evidence that ongoing efforts to de-intensify radiation regimens for this disease lead to gains in function and QOL.