ESTRO 2022

Session Item

Monday

May 09

10:30 - 11:30

Poster Station 2

20: Head and neck

Chair: Annett Linge, Germany

Session Code: 3280

Session Type: Poster Discussion

Track: Clinical

Impact of radiotherapy laterality on patient-reported outcomes in T1-2 HPV tonsillar carcinoma

Lachlan McDowell, Australia

Presentation Number: PD-0822

Abstract

Abstract Title:

Impact of radiotherapy laterality on patient-reported outcomes in T1-2 HPV tonsillar carcinoma

Authors:

Lachlan McDowell^1,2, Danny Rischin^3,2, Madeleine King⁴, Lizbeth Kenny^5,6, Sandro Porceddu^6,7, Christopher Wratten⁸, Andrew Macann⁹, James Jackson¹⁰, Mathias Bressel¹¹, Tsien Fua¹, Charles Lin⁵, Chen Liu¹, June Corry^12,13

¹Peter MacCallum Cancer Centre, Department of Radiation Oncology, Melbourne, Australia; ²University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, Australia; ³Peter MacCallum Cancer Centre, Department of Medical Oncology, Melbourne, Australia; ⁴University of Sydney, Sydney Quality of Life Office, Sydney, Australia; ⁵Royal Brisbane and Women's Hospital, Department of Radiation Oncology, Brisbane, Australia; ⁶University of Queensland, Faculty of Medicine, Brisbane, Australia; ⁷Princess Alexandra Hospital, Department of Radiation Oncology, Brisbane, Australia; ⁸Calvary Mater Hospital and University of Newcastle, Department of Radiation Oncology, Newcastle, Australia; ⁹Auckland City Hospital and University of Auckland, Department of Radiation Oncology, Auckland, New Zealand; ¹⁰Gold Coast Hospital, Icon Cancer Centre, Gold Coast, Australia; ¹¹Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials, Melbourne, Australia; ¹²GenesisCare, GenesisCare St Vincent's Hospital, Melbourne, Australia; ¹³University of Melbourne, Department of Medicine, Melbourne, Australia

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Purpose or Objective

There has been limited patient-reported outcome (PRO) data quantifying differences in risk-comparable patients based on receipt of unilateral radiotherapy (URT) and bilateral radiotherapy (BRT). The aim of this TROG 12.01 substudy was to report longitudinal variations in PROs based on radiotherapy (RT) laterality.

Material and Methods

TROG 12.01 was a multicentre study conducted in Australia and New Zealand randomizing low-risk AJCC7 stage III/IV HPV-associated oropharyngeal cancer patients (HPV+ OPC) to RT (70Gy/35#) with weekly cisplatin or cetuximab. This substudy included patients with lateralized T1-2 N1-2b tonsillar cancer.

PROs were collected at multiple timepoints and included: HNC symptom burden – MDASI-HN, quality of life – FACT-H&N and emotional distress – HADS.

The primary endpoint was the radiation symptom severity score (MDASI-RSS) at 2y, a mean composite score of 9 MDASI-HN symptoms items (pain, fatigue, dry mouth, mucus in mouth/throat, difficulty swallowing/chewing, choking/coughing, taste, mouth/throat sores, teeth/gums). Mean MDASI-RSS, symptom severity (MDASI-SS), symptom interference (MDASI-SI) and selected single item scores were also compared at acute- (1 week [1w] post RT) and late time points (1y/2y) by laterality. FACT-H&N and HADS mean scores were also compared.

Results

There were 74 patients eligible for analysis (26 URT, 48 BRT). Median follow up was 3.7y (1.8-5.2y). Sociodemographic, staging and treatment variables were balanced; however larger primary GTVs (mean URT 7.2cc vs BRT 11.0cc, p=0.013) but not nodal GTVs (17.4 cc vs 20.8cc, p=0.17) were observed in the BRT group.

Failure-free survival (HR=1.5, 95%CI:0.3-6.7) and time to locoregional failure (HR 5.8, 95%CI:0.6-55.8) were not statistically different between the two groups. Four regional failures were reported (3 URT 1 BRT), including 1 isolated contralateral regional failure in the URT cohort.

PRO compliance was high (1y >90%; 2y >80%). The mean MDASI-RSS score (Figure 1) at 2y was URT 1.1 vs BRT 1.3 (estimated difference [ED ] 0.1 [95% CI: -0.7-0.9], p=0.75). There were no significant differences in acute or late MDASI-RSS, MDASI-SS, or MDASI-SI scores, with BRT patients only reporting worse MDASI-SI 1w post RT (4.7 vs 5.6, ED 0.9 [0.0-1.9]). The only individual symptom scores that differed were worse fatigue (6.6 vs 5.4, ED 1.2 95%CI 0.2-2.3) and dry mouth (3.5 vs 2.0, ED 1.5, 95%CI 0.3-2.7) at 1w and 2y after RT, respectively in BRT patients. FACT-H&N and HADS were similar across the follow up period. Duration of enteral feeding was 11.2 weeks for BRT vs 6.7 weeks for URT, p=0.10).

Conclusion

In this favourable risk HPV+ OPC cohort, treatment laterality resulted in fewer differences than had been anticipated, limited to worse acute fatigue and symptom interference and worse late dry mouth in BRT patients. In view of the small sample size, larger prospective studies will be helpful to better define any benefits of URT compared to BRT.