{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:05:45Z","timestamp":1772118345305,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T00:00:00Z","timestamp":1665619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A secondary analysis was performed on a prospective registry data with low\u2010 to intermediate\u2010risk human papillomavirus\u2013related 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\u2013Head and Neck (MDASI\u2010HN) instruments. The likelihoods of PM\/ENE were varied to determine the thresholds within which each therapy remains optimal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with RT, TORS resulted in inferior swallowing function for moderate likelihoods of PM\/ENE (&gt;60% in short term for all instruments, &gt;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\u2010to\u2010high likelihoods of PM\/ENE (&gt;75% for short\u2010term and &gt;40% for long\u2010term outcomes).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.5253","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T01:29:35Z","timestamp":1665710975000},"page":"5088-5098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Optimized decision support for selection of transoral robotic surgery or (chemo)radiation therapy based on\n                    <scp>posttreatment<\/scp>\n                    swallowing toxicity"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-3893","authenticated-orcid":false,"given":"Mehdi","family":"Hemmati","sequence":"first","affiliation":[{"name":"Computational Applied Mathematics and Operations Research William Marsh Rice University  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carly","family":"Barbon","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdallah S. R.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisanne V.","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Radiation Oncology University Medical Center\u2010 Groningen  Groningen Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6762-6807","authenticated-orcid":false,"given":"Amy C.","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9427-0743","authenticated-orcid":false,"given":"Neil D.","family":"Gross","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan P.","family":"Goepfert","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-5706","authenticated-orcid":false,"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Computational Applied Mathematics and Operations Research William Marsh Rice University  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifton D.","family":"Fuller","sequence":"additional","affiliation":[{"name":"Computational Applied Mathematics and Operations Research William Marsh Rice University  Houston Texas USA"},{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the MD Anderson Head and Neck Cancer Symptom Working Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S118891"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.36.4596"},{"key":"e_1_2_11_4_1","unstructured":"National Cancer Institute \u2013 Head and Neck Cancers. 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