Evidence map›Paper›PMID 36229990›Full record

ArticleCancer medicine2023

Optimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on posttreatment swallowing toxicity.

Mehdi Hemmati, Carly Barbon, Abdallah S R Mohamed, Lisanne V van Dijk, Amy C Moreno, Neil D Gross, Ryan P Goepfert, Stephen Y Lai, Katherine A Hutcheson, Andrew J Schaefer and 2 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Cancer medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Observational
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 3 institutions in 2 countries.

Mehdi HemmatiComputational Applied Mathematics and Operations Research, William Marsh Rice University, Houston, Texas, USA.ORCID 0000-0002-0560-3893
Carly BarbonDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abdallah S R MohamedDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Lisanne V van DijkDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Amy C MorenoDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID 0000-0001-6762-6807
Neil D GrossDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID 0000-0002-9427-0743
Ryan P GoepfertDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Stephen Y LaiDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Katherine A HutchesonDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID 0000-0003-3710-5706
Andrew J SchaeferComputational Applied Mathematics and Operations Research, William Marsh Rice University, Houston, Texas, USA.
Clifton D FullerComputational Applied Mathematics and Operations Research, William Marsh Rice University, Houston, Texas, USA.
MD Anderson Head and Neck Cancer Symptom Working Group
The University of Texas MD Anderson Cancer Center · USRice University · USUniversity Medical Center Groningen · NL

Funding

Targeting the p53 pathway for reversal of oral premalignancyP50CA097007 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI EL-NAGGAR, ADEL K. · 2002 to 2012
$26.1M
NRSA Training CoreTL1TR003169 · NCATS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI CHANDRA, JOYA, FROST, JEFFREY A. · 2019 to 2023
$3.7M
SCH: Personalized Rescheduling of Adaptive Radiation Therapy for Head & Neck CancerR01CA257814 · NCI · RICE UNIVERSITY · PI FULLER, CLIFTON DAVID, SCHAEFER, ANDREW J · 2021 to 2024
$1.8M
imaging Radiation-Associated Dysphagia (iRAD)R01CA218148 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI FULLER, CLIFTON DAVID, HUTCHESON, KATHERINE ARNOLD · 2017 to 2019
$810k
Provider and Patient-generated Remote Oro-Dental Health Electronic Data Capture for Algorithmic Longitudinal Evaluation and Risk-Assessment (PROHEALER)K01DE030524 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI MORENO, AMY CATHERINE · 2022 to 2024
$479k
NCATS NIH HHS TL1 TR003169NCI NIH HHS P50 CA097007NCI NIH HHS R01 CA218148NCI NIH HHS R01 CA257814NIDCR NIH HHS K01 DE030524
6 · The paper itself

Abstract

backgroundA primary goal in transoral robotic surgery (TORS) for oropharyngeal squamous cell cancer (OPSCC) survivors is to optimize swallowing function. However, the uncertainty in the outcomes of TORS including postoperative residual positive margin (PM) and extranodal extension (ENE), may necessitate adjuvant therapy, which may cause significant swallowing toxicity to survivors.

methodsA secondary analysis was performed on a prospective registry data with low- to intermediate-risk human papillomavirus-related OPSCC possibly resectable by TORS. Decision trees were developed to model the uncertainties in TORS compared with definitive radiation therapy (RT) and chemoradiation therapy (CRT). Swallowing toxicities were measured by Dynamic Imaging Grade of Swallowing Toxicity (DIGEST), MD Anderson Dysphagia Inventory (MDADI), and the MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) instruments. The likelihoods of PM/ENE were varied to determine the thresholds within which each therapy remains optimal.

resultsCompared with RT, TORS resulted in inferior swallowing function for moderate likelihoods of PM/ENE (>60% in short term for all instruments, >75% in long term for DIGEST and MDASI) leaving RT as the optimal treatment. Compared with CRT, TORS remained the optimal therapy based on MDADI and MDASI but showed inferior swallowing outcomes based on DIGEST for moderate-to-high likelihoods of PM/ENE (>75% for short-term and >40% for long-term outcomes).

conclusionIn the absence of reliable estimation of postoperative PM/ENE concurrent with significant postoperative PM, the overall toxicity level in OPSCC patients undergoing TORS with adjuvant therapy may become more severe compared with patients receiving nonsurgical treatments thus advocating definitive (C)RT protocols.

Indexed as

Head and Neck NeoplasmsOropharyngeal NeoplasmsRobotic Surgical ProceduresDeglutitionHumansSquamous Cell Carcinoma of Head and Neckdecision analysisdefinitive (chemo)radiation therapyhead-and-neck canceroropharyngeal squamous cell cancerposttreatment toxicitytransoral robotic surgery

Identifiers

PMID36229990
PMCPMC9972156
OpenAlexW4306158024

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.