Affiliation:
1. Department of Otolaryngology‐Head and Neck Surgery University of California San Francisco California USA
2. Department of Otolaryngology‐Head and Neck Surgery University of Tennessee‐Memphis Memphis Tennessee USA
3. Department of Otorhinolaryngology‐Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
4. Department of Radiation Oncology University of California San Francisco California USA
5. Division of Hematology and Oncology University of California San Francisco California USA
Abstract
AbstractObjectivesTo compare post‐treatment neck and shoulder function between human papillomavirus‐associated oropharynx squamous cell carcinoma (HPV + OPSCC) treatments.DesignProspective, repeated‐measures study.SettingTertiary care center.ParticipantsTreatment‐naïve patients with American Joint Committee on Cancer eighth edition stage T0‐3/N0‐2 HPV+OPSCC.Main Outcome MeasuresPatients completed the Neck Dissection Impairment Index (NDII) pre‐treatment and 3‐months and 1‐year post‐treatment. The NDII assesses 10 neck and shoulder functions scored 0–5 (total score 0–100), with higher scores suggesting better function.ResultsA total of 106 patients underwent: surgery alone (SA, n = 46, 43%), surgery with adjuvant radiation ± chemotherapy (S + a[C]XRT, n = 18, 17%), or definitive radiation ± chemotherapy (d[C]XRT, n = 42, 40%). cTN classification and pre‐treatment NDII scores did not differ between groups. SA patients reported worsened 3‐month post‐treatment versus pre‐treatment self‐care (4.6 vs. 5.0), lifting light (4.6 vs. 5.0) and heavy (4.2 vs. 4.8) objects, overhead reach (4.5 vs. 4.9), activity (4.5 vs. 4.9), socialization (4.7 vs. 4.9), recreation (4.6 vs. 4.9), and overall score (86.8 vs. 95.3) (all p < 0.05). One‐year post‐treatment scores (n = 34) were no different than pre‐treatment in all domains. S + a[C]XRT patients reported worsened 3‐month versus pre‐treatment stiffness (4.0 vs. 4.8), lifting heavy objects (3.8 vs. 4.9), overhead reach (4.2 vs. 4.9), socialization (4.6 vs. 5.0), recreation (4.4 vs. 4.9) and overall score (82.4 vs. 96.0) (all p < 0.05). One‐year post‐treatment scores (n = 13) were no different than pre‐treatment in all domains. d[C]XRT patients reported worsened 3‐month versus pre‐treatment difficulty lifting heavy objects (4.3 vs. 4.7) and recreation (4.3 vs. 4.7). One‐year posttreatment scores (n = 21) were no different than pre‐treatment in all domains.ConclusionHPV + OPSCC patients may experience mild shoulder/neck dysfunction 3 months after treatment that usually resolves by 1 year, independent of treatment modality.