As reported in the Journal of Clinical Oncology by Nichols et al, final results of the phase II ORATOR trial indicate some differences in toxicity and quality of life between radiotherapy and transoral robotic surgery for oropharyngeal squamous cell carcinoma, with both approaches yielding similar and “excellent” oncologic outcomes.
Study Details
In the trial, 68 patients from sites in Canada and Australia with T1-2N0-2 oropharyngeal squamous cell carcinoma were randomly assigned between August 2012 and June 2017 to receive radiotherapy at 70 Gy in 35 fractions (with chemotherapy if node-positive, n = 34) or transoral robotic surgery plus neck dissection (with or without adjuvant radiotherapy plus chemoradiation depending on pathologic findings, n = 34). The primary outcome measure was swallowing quality of life assessed with the MD Anderson Dysphagia Inventory (MDADI). The current analysis presents findings at 5 years after enrollment completion.
Key Findings
The median follow-up for this analysis was 5.1 years (interquartile range = 5.0–5.3 years). MDADI total scores converged by 5 years and did not significantly differ between groups throughout the follow-up period (P = .11).
Grade 2 to 5 adverse event rates did not differ between the radiotherapy group and the transoral robotic surgery group (91% vs 97%, P = .61); neutropenia and hearing loss were more common in the radiotherapy group, and dysphagia and other pain were more common in the transoral robotic surgery group (all P < .05). Assessment with the EORTC QLQ-C30 and H&N35 instruments showed differing profiles between groups—eg, worse dry mouth in the radiotherapy group (P = .032) and worse pain in the transoral robotic surgery group (P = .002).
At 5 years, for the radiotherapy group vs the transoral robotic surgery group, progression-free survival was 84.0% vs 82.2% (hazard ratio [HR] = 1.14, P = .83) and overall survival was 84.0% vs 85.1% (HR = 0.94, P = .92).
The investigators concluded: “[T]oxicity and [quality of life] profiles differ in some domains between [radiotherapy] and [transoral robotic surgery], but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.”
Anthony C. Nichols, MD, of Western University, London, Ontario, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by a Canadian Cancer Society Research Institute Quality of Life grant, a Clinician Scientist grant from the Ontario Institute for Cancer Research, and others. For full disclosures of the study authors, visit ascopubs.org.
