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Is Radiation or Chemoradiation Best for Oropharyngeal Cancer Patients

Patients with stage IV oropharyngeal cancer -- a type of cancer that develops in the part of the throat just behind the mouth// that assists with breathing, talking, eating, chewing, and swallowing -- are often treated with radiation alone or with chemoradiation. The addition of chemotherapy is usually based on the need for radiotherapy sensitizers and the perceived risk for the spread of cancer cells from the original site to other parts of the body.

In the oropharyngeal cancer population with small volume primary disease and moderate metastatic disease in the lymph nodes, the role of chemotherapy is less clear. But, as chemoradiation for oropharyngeal cancer has become more common and survival is stabilizing, the question of long-term function is becoming important. There is an assumption that combined therapy may lead to increased dysphagia, or difficulty in swallowing and feeding tube dependence.

This study is a retrospective chart review of all patients presenting at MD Anderson Cancer Center with T1 or T2 tonsil or base of tongue squamous cell carcinoma and N2a or N2b cervical lymph node metastasis between January 2000 and December 2004. Only patients who received their radiation treatment at this institution were included. Charts were reviewed for demographic features, staging information, and method of treatment. When available, pre- and post-treatment swallowing evaluations were analyzed. The functional outcomes for swallowing were the presence or absence of feeding (PFG) tubes, diet status, and swallow evaluation results including dysphagia and aspiration. The two-tailed Fisher exact test and Pearson’s chi square were used for statistical analysis.

120 charts were reviewed – 84 received radiation alone (RT) while 32 received combined chemoradiation (CRT). The overall survival was 98 percent. More CRT patients required PFG tube placement during treatment than RT patients. However, both groups had equal rates of PFG remo
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