Short-Term Symptom and Functional Outcomes Following Definitive Chemoradiotherapy Versus Surgery Plus Adjuvant Radiotherapy in Locally Advanced Oral Cavity Squamous Cell Carcinoma

Background Patients with locally advanced oral cavity squamous cell carcinoma (OCSCC) often experience symptoms that interfere with eating, swallowing, comfort, and daily functioning. Surgery followed by adjuvant radiotherapy (RT) remains the standard treatment for operable disease, whereas definitive concurrent chemoradiotherapy (CCRT) is used selectively in patients who are unsuitable for, unwilling to undergo, or unable to undergo timely surgery. Objective This study compared short-term symptom burden and functional outcomes between patients with locally advanced OCSCC treated with definitive CCRT and those treated with surgery followed by adjuvant RT. Methods This prospective, non-randomized comparative cohort study was conducted at two cancer centers in Bangladesh from January 2023 to October 2024. Sixty-eight previously untreated patients with stage III or IVA OCSCC were included. Thirty-four patients received definitive CCRT, and 34 underwent surgery followed by adjuvant RT. Symptom burden and functional status were assessed using the Functional Assessment of Cancer Therapy Head and Neck Symptom Index-10-item version (FACT-HNSI-10). The primary outcome was the change in the FACT-HNSI-10-derived raw symptom burden score from baseline to post-treatment assessment. Secondary outcomes included changes in pain, dysphagia, bleeding or ulceration, and respiratory distress. Results FACT-HNSI-10-derived raw symptom burden scores decreased significantly after treatment in both groups, indicating improvement in symptom burden according to the scoring approach used in this study. The mean score decreased from 30.2±0.8 to 24.8±1.3 in the chemoradiotherapy group and from 30.0±1.0 to 24.4±1.3 in the surgery plus adjuvant RT group (both p<0.001). The mean change did not differ significantly between groups (5.4±1.3 vs. 5.6±1.0; p=0.471). Pain, dysphagia, bleeding or ulceration, and respiratory distress decreased during short-term follow-up in both arms. Conclusions Both treatment pathways were associated with short-term decreases in FACT-HNSI-10-derived raw symptom burden scores and improvements in symptom burden. No statistically significant difference was observed between groups in short-term functional improvement. These findings should be interpreted cautiously because of the small sample size, non-randomized design, and limited follow-up. They do not establish oncologic equivalence.