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. 2025 Nov 25;16(1):2165.
doi: 10.1007/s12672-025-03896-z.

Patient-reported outcomes after ipsilateral radiation therapy for N2b tonsillar squamous cell carcinoma

Chike O Abana  1 , Adam S Garden  1 , G Brandon Gunn  1 , Gregory M Chronowski  1 , Abdallah S R Mohamed  1 , Andrew J Frankart  2 , Natalie Geier  3 , Houda Bahig  4 , Carly E A Barbon  5 , Kate Hutcheson  5 , Vinita Takiar  2 , Clifton D Fuller  1 , Steven J Frank  1 , David I Rosenthal  1 , Jack Phan  6
Affiliations

Patient-reported outcomes after ipsilateral radiation therapy for N2b tonsillar squamous cell carcinoma

Chike O Abana et al. Discov Oncol. .

Abstract

Background: Previous studies have reported excellent disease control and survival in patients with well-lateralized, American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar squamous cell carcinoma (SCC). The reduced treatment volume is associated with lower rates of physician-assessed toxicity. Patient-reported outcomes (PROs) have been proposed as a similarly reliable measure, but the body of literature is limited for unilaterally treated patients. Our goal was to review PROs of such patients who had reduced treatment volumes.

Methods: We reviewed PROs of patients with AJCC-7 T1-2N2b disease treated with ipsilateral radiation therapy (RT), with or without surgery or chemotherapy before RT. PROs were measured using the MD Anderson Symptom Inventory for head and neck cancer after a median of 28.9 months.

Results: Forty-eight patients were included in the study: 36 (75%) had human papillomavirus-positive disease, 20 (42%) had ≥ 2 nodal levels involved, 15 (31%) had extranodal extension and all patients had N2b disease. Most patients reported no symptoms; a median 72.9% for all 10 head-and-neck symptoms, 75.0% for all 12 core symptoms, and 83.3% for all 6 interference symptoms reported a score of “0”. The most common head-and-neck and core symptoms were dry mouth (n = 33, 69%) and fatigue (n = 23, 48%). Treatment mostly interfered with general activities. PROs were not affected by receipt of surgery; however, receipt of systemic therapy was associated with worse general activity (P = 0.044). Longitudinal analyses revealed mildly worse dry mouth (from 0 of 10 points to 1.5 of 10, P = 0.012) and numbness/tingling (from 0 of 10 to 0.5 of 10, P = 0.020).

Conclusions: Ipsilateral neck RT for N2b tonsil SCC was associated with only a mild PRO symptom burden after at least 18 months, and therefore, a well-tolerated toxicity reduction strategy for appropriate patients.

Keywords: HPV; MD Anderson symptom inventory for head and neck; MDADI; MDASI; PRO; Toxicity; Unilateral radiation therapy; Xerostomia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by The University of Texas MD Anderson Cancer Center Institutional Review Board for HN IMRT protocol PA2014-0194. Informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distributions of MDASI-HN patient-reported outcomes. Patient-reported scores for the A MDASI-HN domain B Core domain, and C Interference domain. Colors indicate severity scores from 0 (not present) to 10 (as bad as you can imagine). MDASI-HN, MD Anderson Symptom Inventory—Head and Neck Cancer
Fig. 2
Fig. 2
Association of general activity scores of MDASI—interference domains with the administration of systemic therapy. Data from 16 patients who did not receive systemic therapy and 32 patients who received induction chemotherapy, concurrent chemotherapy, or both are shown. Error bars represent medians with interquartile ranges. MDASI, MD Anderson Symptom Inventory. P ≤ 0.05 indicates a statistically significant difference
Fig. 3
Fig. 3
Longitudinal changes in dry mouth scores of the MDASI-HN domains. Data pairs of 18 patients from baseline to at least 18 months after radiation therapy are shown and connected with stems. MDASI-HN, MD Anderson Symptom Inventory—Head and Neck Cancer. P ≤ 0.05 indicates a statistically significant difference
Fig. 4
Fig. 4
Longitudinal changes in numbness and tingling scores of the MDASI core domains. Data pairs of 18 patients from baseline to at least 18 months after radiation therapy are shown and connected with stems. MDASI, MD Anderson Symptom Inventory. P ≤ 0.05 indicates a statistically significant difference
See this image and copyright information in PMC

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