Adding more evidence to the comparison between radiation therapy and surgery in treating an increasingly diagnosed head and neck cancer, a new study by researchers at UT Southwestern Medical Center found no major long-term differences in the effectiveness of the two therapies.

Given these results, investigators suggest quality-of-life factors should help inform a treatment decision. The study was published in JAMA Otolaryngology-Head & Neck Surgery.

Oropharyngeal Squamous Cell Carcinoma

The investigators performed a comparative effectiveness analysis in patients with oropharyngeal squamous cell carcinoma, or OPSCC, focusing on survival, side effects, and costs. The study merged the HealthCore Integrated Research Database with state cancer registry data to identify 884 patients diagnosed with OPSCC from 2007 to 2014.

The authors found no statistical differences between radiotherapy vs surgery in overall survival, long-term gastrostomy dependence (stomach tube use), esophageal dilation or restriction, and bone toxicity effects. There was, however, an increase in acute gastrostomy use among radiotherapy patients who also received chemotherapy.

Head & Neck Cancer

While historical treatment outcomes for oropharyngeal cancer were quite poor, the combination of treatment innovations and more favorable tumor biology have resulted in 3-year survival for over 75% of patients in this analysis.

Dr. Sher believes that future research in this area should focus not just on oncologic results but also on the patient quality of life and functional outcomes. Both local therapy paradigms for HPV-associated oropharyngeal cancer are expected to change significantly over the next 5 years, so it is crucial to prospectively study the impact of novel treatment approaches on patient-centered outcomes.

The study was funded by the Radiation Oncology Institute and coauthored by HealthCore, the outcomes research subsidiary for Anthem, Inc. It further showed that, for both treatments, costs were about $100,000 for payers and $5,000 for patients.

The absence of any significant cost differences further emphasizes how central patient-reported outcomes will be on the comparative value of the two therapies.

Our findings suggest that patient preference can be the main driver of local therapy selection as both surgery and radiation therapy were equally viable choices in terms of clinical outcomes with no cost difference.