Comparative analysis of functional outcomes and quality of life following transoral CO2 laser microsurgery versus definitive radiation therapy in patients with early-stage HPV-associated oropharyngeal cancer
- 1Nonprofit Organization National cancer institute, Kyiv, Ukraine
- 2Bogomolets National Medical University, Kyiv, Ukraine
Summary. The incidence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) has been rising steadily over the past two decades, reaching epidemic proportions in developed countries. Owing to the favorable biological profile of HPV-positive tumors, patients with early-stage disease demonstrate high 5-year overall survival rates of 85–90%, and consequently live for extended periods with the sequelae of treatment. In this context, long-term functional outcomes and quality of life assume paramount importance, and dysphagia — one of the most prevalent and debilitating complications of both the disease and its treatment — becomes a key criterion for evaluating therapeutic strategies. Objective. To compare functional outcomes and quality of life, as assessed by the M.D. Anderson Dysphagia Inventory (MDADI) and EORTC Quality of Life Head and Neck Module (QLQ-H&N35) questionnaires, following transoral CO2 laser microsurgery (TLM) versus definitive radiation therapy as primary treatment modalities for early-stage HPV-positive oropharyngeal carcinoma. Materials and methods. This prospective comparative clinical study enrolled 64 patients with HPV-positive oropharyngeal carcinoma (T1–T2, N0–N2). The TLM group comprised 33 patients, and the definitive radiation therapy (DRT, 66–70 Gy) group comprised 31 patients. Functional outcomes were evaluated using the MDADI questionnaire, and quality of life was assessed using the EORTC QLQ-H&N35 at 5 time points: baseline, day 7, day 30, 6 months, and 12 months. Statistical analysis included Student’s t-test or Mann — Whitney U-test, linear mixed-effects models, Fisher’s exact test, and multivariable regression analysis. Results. On day 7 following treatment initiation, the TLM group exhibited a marked decline in MDADI scores compared with the DRT group (68.2±11.1 vs 79.7±6.4; p <0.001), reflecting the acute postoperative period. However, at 6 and 12 months, swallowing function was significantly superior in the TLM group compared with the DRT group (83.8±8.6 vs 71.4±12.7; p <0.001). A similar trend was observed for quality-of-life measures: at 12 months, QLQ-H&N35 scores were lower (indicating better outcomes) in the TLM group than in the DRT group (16.8±9.5 vs 29.2±8.5; p <0.001). Linear mixed-effects models confirmed a statistically significant time × treatment modality interaction for both MDADI (β=0.0498; p <0.001) and QLQ-H&N35 (β=−0.0450; p <0.001). Multivariable analysis demonstrated that assignment to the TLM group was an independent predictor of superior functional outcomes (β=12.02; p <0.001) and lower symptom burden (β=−12.44; p <0.001) at 12 months. Conclusions. Despite more pronounced acute functional deterioration in the early postoperative period, transoral CO2 laser microsurgery yields significantly better swallowing function and lower symptom burden at 12 months compared with definitive radiation therapy (MDADI: 83.8±8.6 vs 71.4±12.7; p <0.001; QLQ-H&N35: 16.8±9.5 vs 29.2±8.5; p <0.001). Multivariable analysis identified surgical treatment group assignment as an independent predictor of superior functional outcomes (β=12.02; p <0.001) and lower symptom burden (β=−12.44; p <0.001), confirming the advantage of transoral microsurgery in patients with early-stage HPV-positive oropharyngeal carcinoma.
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