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Swallowing function after treatment for early-stage OPC
Secondary functional outcomes
Secondary functional outcomes of participants offered surgery or RT only are shown in Appendix 5. Figure 1 illustrates the RRs per outcome measure at 4- and 12-month follow-up. Participants offered RT reported more problems with weight loss and dry mouth compared to those who were offered surgery. In contrast, participants offered surgery had more trouble opening their mouth, especially at 4-month follow-up. Eight (33%) of the 24 participants with mouth opening problems at 4-month follow-up had a reconstruction with a free flap in contrast to 11 (18%) of the 61 participants who did not have trouble opening their mouth. At 12-month follow-up, only 4% of the participants used tube feeding in both groups.
As with the self-reported swallowing problems, differences between functional outcomes were more prominent between RT and surgery when only participants were included who received their intended single-modality treatment (Appendix 7). Participants who received adjuvant treatment after surgery had more secondary functional problems than participants who received surgery only, especially weight loss, feeding tube use, pain, dry mouth, and altered taste.
Functional outcomes of participants with T1N0 OPC
When baseline characteristics as well as functional outcomes between participants with T1N0 offered surgery and RT were compared, the same patterns in differences between surgery and RT were seen compared to those of all early-stage OPC participants (Appendix 8 and 9).
Presence of disease and survival
The 1-year overall survival (OS) was 96% vs. 93% for participants offered surgery and RT respectively. The 3-year OS was 89% and 79% for surgery and RT and the 5-year OS was 80% and 68% respectively. At 12-month follow-up, 89% and 87% of the participants offered surgery and RT respectively were alive without any signs of residual/recurrent disease. The adjusted HR for death of participants who were offered RT compared to participants who were offered surgery was 1.7 (95% CI 0.7–3.8, p = .219). Participants who were both offered and received RT had an adjusted HR of death of 2.2 (95% CI 0.7–7.2, p = .189) compared to participants who both were offered and received surgery. The associations were similar in minimally adjusted models. Kaplan Meier curves are presented in Figure 3 (survivor functions were more unstable with increasing follow-up time since the latter estimates are based on smaller sample sizes).
Influence of HPV-status
Baseline characteristics of participants stratified by HPV-status are presented in Appendix 10. In both the HPV-negative and -positive group, participants offered RT were older, had more comorbidities, and more pre-treatment swallowing problems. Within the HPV-positive group, RT participants had more T2-tumours, lower N classification, and HPV-positive participants offered surgery needed adjuvant (C)RT more often than HPV-negative participants (70% vs. 38%).
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