One-year evolution of the quality of life in patients with locally advanced human papilloma virus positive treated with neoadjuvant chemotherapy followed by transoral robotic surgery and neck dissection
Bibliographic record
Abstract
Background: Oropharyngeal cancer is the most common type of head and neck cancers, with a 5-year survival of 64.7%. Over the last 40 years, such risk factors and aetiology have changed, with a reduced incidence due to usage of tobacco and alcohol, but with an increased incidence due to Human Papilloma Virus (HPV) infection in 70% of cases. Chronic treatment-related toxicity and functional loss of the standard of care concurrent chemoradiation (CRT) have had a significant impact on the quality of life (QOL) of survivors of oropharyngeal squamous cell carcinoma (OPSCC). Currently, there are different de-escalation treatments and trials that aim to reduce the treatment-related toxicity while maintaining the survival for locally advanced OPSCC. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ30) is the quality of life questionnaire most used worldwide to assess the quality of life of cancer patients.Objectives: The objectives of this thesis are: (a) to review literature on 1-year evolution of quality of life of patients treated for OPSCC with standard of care CRT, and (b) to assess the quality of life in human papillomavirus positive (HPV+) OPSCC patients with locoregionally advanced disease treated with the experimental treatment neoadjuvant chemotherapy (NeC) followed by transoral robotic surgery (TORS) as definitive treatment. Methods: The first study was a narrative literature review of treated OPSCC patients assessed with EORTC QLQ-30 and EORTC Head and Neck -35 (a) at pre-treatment, and (b) at 12-months post-treatment. The second study was a prospective cohort study that took place at McGill University Health Centre in Montreal, Canada. Patients were diagnosed with stage III and IV (according to AAJC 7th edition) HPV+ OPSCC and treated with NeC (docetaxel and cisplatin) followed by TORS and selective neck dissection, between January 2017 and July 2018.Results: a) The first study showed that standard-of-care treatment surgery and adjuvant radiotherapy or more commonly utilized CRT produced chronic side effects, such as xerostomia, poor oral and dental health, dysphagia, feeding tube dependency, and other fibrotic changes likely caused by radiotherapy. or a combination of surgery and radiotherapy. b) The second study (19 eligible HPV+ patients of 23 recruited; 90% male; median age: 58; 7 patients with localized base-of-tongue cancer; 12 with localized palatine-tonsil cancer) showed that EORTC- H&N35 scores at 12-month post-treatment were not significantly different than pre-treatment values in the scales known to be most affected by standard of care CRT treatment toxicity, such as swallowing (p = 0.38), social eating problems (p = 0.70), or dry mouth and sticky saliva (p = 0.87). No patient in this cohort required a gastrostomy tube (PEG) at any time-point assessed. Conclusions: Results of the first literature-review study showed that chronic standard of care CRT treatment-related toxicity and functional loss, such as xerostomia, poor oral and dental health, dysphagia, as well as feeding tube dependency, had a significant negative impact on the 1-year QOL of survivors of oropharyngeal squamous cell carcinoma (OPSCC). Results of the second prospective study showed that QOL 12 months post-NeC-TORS treatment returned to the pre-treatment baseline, or improved, on all scales, including the symptom scales that are most negatively affected by the current standard of care treatment CRT. Patients had a rapid return to an oral diet. Findings suggest that NeC followed by TORS provides maintenance of QOL and improvement in many areas compared to pre-treatment levels
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".