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Functional swallowing outcomes following treatment for oropharyngeal carcinoma: A systematic review of the evidence comparing trans-oral surgery versus non-surgical management

Lookup NU author(s): Dr Joanne Patterson, James O'HaraORCiD


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BackgroundTrans-oral surgical and non-surgical management options for oropharyngeal squamous cell carcinoma (OPSCC) appear to offer similar survival outcomes. Functional outcomes, in particular swallowing, have become of increasing interest in the debate regarding treatment options. Contemporary reviews on function following treatments frequently include surrogate markers and limit the value of comparative analysis.Objectives of reviewA systematic review was performed to establish if direct comparisons of swallowing outcomes could be made between trans-oral surgical approaches (trans-oral laser microsurgery (TLM)/ trans-oral robotic surgery (TORS)) and (chemo)radiotherapy (C)RT.Type of review Systematic review Search strategyMEDLINE, EMBASE, and Cochrane databases interrogated using the following MeSH terms: Antineoplastic protocols, chemotherapy, radiotherapy, deglutition disorders, swallowing, lasers, trans-oral surgery.Evaluation methodTwo authors performed independent systematic reviews and consensus sought if opinions differed. The WHO ICF classification was applied to generate analysis based around body functions and structure, activity limitations and participation restriction.ResultsThirty-seven citations were included in the analysis. Twenty-six papers reported outcomes for OPSCC treatment following primary (C)RT in 1377 patients, and 15 papers following contemporary trans-oral approaches in 768 patients.Meta-analysis was not feasible due to varying methodology and heterogeneity of outcome measures. Instrumental swallowing assessments were presented in 13/26 (C)RT versus 2/15 TLM/TORS papers. However, methods of reporting these studies were not standardised. This variety of outcome measures and the wide-ranging intentions of authors applying the measures in individual studies limit any practical direct comparisons of the effects of treatment on swallowing outcomes between interventions.ConclusionsFrom the current evidence, no direct comparisons could be made of swallowing outcomes between the surgical and non-surgical modalities. Swallowing is a multi-dimensional construct and the range of assessments utilised by authors reflects the variety of available reporting methods. The MDADI is a subjective measure that allows limited comparison between the currently available heterogeneous data, and is explored in detail. The findings highlight that further research may identify the most appropriate tools for measuring swallowing in OPSCC patients. Consensus should allow their standardised integration into future studies and randomised-control trials.

Publication metadata

Author(s): Dawe N, Patterson J, OHara J

Publication type: Article

Publication status: Published

Journal: Clinical Otolaryngology

Year: 2016

Volume: 41

Issue: 4

Pages: 371-385

Print publication date: 01/08/2016

Online publication date: 21/08/2015

Acceptance date: 10/08/2015

ISSN (print): 1749-4478

ISSN (electronic): 1749-4486

Publisher: Wiley-Blackwell


DOI: 10.1111/coa.12526


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