Two-Year Patient-Reported Outcomes after Ipsilateral IMRT for T1-2 N2b Squamous Cell Carcinoma of the Tonsils

Abstract

<h3>Purpose/Objective(s)</h3> Although unilateral neck irradiation is frequently implemented in patients with well-lateralized stage T1-2 HPV+ tonsillar squamous cell carcinoma (SCC) to minimize toxicity, its role in patients with N2b (AJCC-7 staging) nodal disease remains controversial. We have separately reported on contralateral nodal recurrence risk in patients with N2b disease receiving unilateral neck radiation. The quality-of-life patient reported outcomes (PRO) in these patients have not been previously reported. Our hypothesis was that patients with AJCC 7^th edition T1-2 N2b tonsillar squamous cell carcinoma treated with unilateral neck radiation had mild quality-of-life PROs. <h3>Materials/Methods</h3> The PROs of 44 AJCC-7 T1-2 N2b tonsillar squamous cell carcinoma (SCC) patients from two academic institutions treated with definitive, ipsilateral intensity modulation radiation therapy (IMRT) with or without systemic therapy were reviewed retrospectively. PROs were completed using either the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN) at the first institution, or the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module 35 (EORTC QLQ-H&N35) at the second institution. The primary endpoint was the head and neck-related PROs at 2 years after completion of radiation. <h3>Results</h3> Twenty-eight of 30 and 4 of 14 patients from the first and second institutions, respectively, met the primary endpoint and were further analyzed. Of these, 34.4% received radiation alone without systemic therapy and 93.7% received ipsilateral-only neck IMRT. The most common head and neck-related PRO was dry mouth at the first and second institutions (64.2% and 100%, respectively); the least common was difficulty with voice or speech at both institutions (14% and 0%, respectively). There were also no reports of mouth pain or soreness, trouble with teeth, opening mouth, or swallowing liquid/pureed food at the second institution. The overall symptom severity for all PRO categories in both modules were in the mild range, with the highest mean score reported for dry mouth: 2.54 out of 10 on MDASI-HN for the first institution and 2.5 out of 4 on EORTC QLQ-H&N35 for the second institution. The rest of the mean scores for the first institution were < 1.5, while the remainder for the second institution were ≤ 2. The locoregional control and overall survival after a median follow-up of 4.5 years were each 100%. <h3>Conclusion</h3> We assessed the 2-year quality-of-life PROs for ipsilaterally radiated tonsillar SCC from 2 institutions using either MDASI-HN or EORTC QLQ-H&N35, and most patients reported mild symptom burden. These findings suggest that ipsilateral-only IMRT is well tolerated in patients with AJCC-7 N2b disease and can be safely employed as a de-escalation strategy.