Functional Impact of Transoral Surgery and Risk-Based Adjuvant Therapy in Human Papillomavirus–Associated Oropharyngeal Cancer: Swallowing Outcomes From ECOG-ACRIN E3311

PURPOSE The ECOG-ACRIN E3311 phase II trial demonstrated outstanding disease control (90.6% 54-month progression-free survival) after transoral surgery (TOS) with de-escalated, risk-based postoperative management in resectable human papillomavirus–associated oropharyngeal cancer. The goal of de-escalation was functional preservation. The objective of this work was to evaluate clinician-graded modified barium swallow (MBS) studies from E3311 over time and across arms for (1) aspiration and high-grade pharyngeal residue rates, (2) differences in swallow safety and efficiency, and (3) accuracy of site clinicians reporting against central MBS review. METHODS Eight hundred eighty-five MBS studies were performed on 314 patients from 50 of 59 sites at baseline, post-TOS, and 6 and 24 months postradiotherapy (RT). Swallow outcomes (aspiration, high-grade residue) were recorded by site clinicians. A subset of 414 MBS studies was centrally graded using penetration-aspiration scale scores and the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. RESULTS Aspiration, residue, and dysphagia rates significantly increased from baseline to post-TOS ( P < .01) and then decreased modestly at 6 and 24 months. At 6 months, swallow outcomes favored the 50- versus 60-Gy arm, with significantly lower aspiration and high-grade dysphagia rates, but this difference was not maintained at 24 months. MBS results reported by site clinicians demonstrated substantial agreement with those assessed by the central laboratory (PABAK, 0.75-0.84; P < .01). CONCLUSION Swallowing worsened after TOS but improved by 6 and 24 months despite adjuvant therapy. De-escalated adjuvant RT at 50 Gy reduced acute aspiration. Site-reported MBS metrics strongly aligned with DIGEST, showing potential as an accessible metric in cooperative group settings.

Authors

Institutions

Publication Details

Journal
JCO oncology advances.
Published
2025-11-01
DOI
https://doi.org/10.1200/oa-25-00092
Citations
1
Primary Topic
Head and Neck Cancer Studies
Type
article
Field-Weighted Citation Impact
1.85
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Functional Impact of Transoral Surgery and Risk-Based Adjuvant Therapy in Human Papillomavirus–Associated Oropharyngeal Cancer: Swallowing Outcomes From ECOG-ACRIN E3311

Russel B. Smith, F. Christopher Holsinger, Barbara Ann Burtness, Yael Flamand et al.
1 citations
JCO oncology advances.
Head and Neck Cancer Studies
1.85
article

Functional Impact of Transoral Surgery and Risk-Based Adjuvant Therapy in Human Papillomavirus–Associated Oropharyngeal Cancer: Swallowing Outcomes From ECOG-ACRIN E3311

Russel B. Smith, F. Christopher Holsinger, Barbara Ann Burtness, Yael Flamand, Harry Quon, Wayne M. Koch, Katherine A. Hutcheson, Nabil F. Saba, Francisco Civantos, Jan S. Lewin, Saral Mehra, Ranee Mehra, Carly E. A. Barbon, R. Bryan Bell, Neil D. Gross, Tom R Thomas, Beatrice Manduchi, Robert L. Ferris, Christine B. Peterson, Thomas J. Gal, Seungwon Kim, Gregory Steven Weinstein, Enver K. Ozer
article en
1 citations

Abstract

PURPOSE The ECOG-ACRIN E3311 phase II trial demonstrated outstanding disease control (90.6% 54-month progression-free survival) after transoral surgery (TOS) with de-escalated, risk-based postoperative management in resectable human papillomavirus–associated oropharyngeal cancer. The goal of de-escalation was functional preservation. The objective of this work was to evaluate clinician-graded modified barium swallow (MBS) studies from E3311 over time and across arms for (1) aspiration and high-grade pharyngeal residue rates, (2) differences in swallow safety and efficiency, and (3) accuracy of site clinicians reporting against central MBS review. METHODS Eight hundred eighty-five MBS studies were performed on 314 patients from 50 of 59 sites at baseline, post-TOS, and 6 and 24 months postradiotherapy (RT). Swallow outcomes (aspiration, high-grade residue) were recorded by site clinicians. A subset of 414 MBS studies was centrally graded using penetration-aspiration scale scores and the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale. RESULTS Aspiration, residue, and dysphagia rates significantly increased from baseline to post-TOS ( P < .01) and then decreased modestly at 6 and 24 months. At 6 months, swallow outcomes favored the 50- versus 60-Gy arm, with significantly lower aspiration and high-grade dysphagia rates, but this difference was not maintained at 24 months. MBS results reported by site clinicians demonstrated substantial agreement with those assessed by the central laboratory (PABAK, 0.75-0.84; P < .01). CONCLUSION Swallowing worsened after TOS but improved by 6 and 24 months despite adjuvant therapy. De-escalated adjuvant RT at 50 Gy reduced acute aspiration. Site-reported MBS metrics strongly aligned with DIGEST, showing potential as an accessible metric in cooperative group settings.

JCO oncology advances.(2)
University of Maryland, Baltimore (US), The University of Texas MD Anderson Cancer Center (US), University of Kentucky (US), Johns Hopkins University (US), University of Miami (US), Emory University (US), Providence Portland Medical Center (US), Markey Cancer Center (US), Jackson Memorial Hospital (US), Yale University (US), Memorial Hospital (US), Dana-Farber Cancer Institute (US), Palo Alto Institute (US), Mayo Clinic in Arizona (US), UPMC Hillman Cancer Center (US), Dana-Farber/Harvard Cancer Center (US), U-M Rogel Cancer Center (US), Stanford Cancer Institute, UNC Lineberger Comprehensive Cancer Center, The Ohio State University (US), University of Pennsylvania (US), The University of Texas Health Science Center at Houston (US)
Openalex Percentile: Top 11%
Head and Neck Cancer Studies
1.85
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.