Performance status after treatment for XXXX --a comparison of primary radiation therapy versus primary surgery.

@entity1 @entity135 @entity5773 @entity7279 @entity5 @entity1544 @entity1442
PURPOSE: To compare the quality of life and functional outcome in @entity1 with @entity1544 treated with primary radiation vs. primary surgery. METHODS AND MATERIALS: At our institution, @entity1 with @entity5 are primarily treated either by radiation or surgery depending upon the philosophy of their primary physician. Primary radiation consists of 45-54 Gy external beam radiation followed by an 192Ir implant delivering an additional 20-30 Gy over 2-3 days. A neck dissection is done at the same time as the implant for those with involved nodes. Primary surgery consists of resection of the base of @entity5773 , neck dissection and postoperative radiation therapy. Because both groups have similar local control in our experience (80-90%), we used a subjective performance status scale for @entity135 @entity1 to assess the quality of life in these @entity1 (0-100, 0 = worst function, 100 = normal function). This scale measures ability to eat in public, understandability of speech, and normalcy of diet. There were 30 radiation @entity1 (21: T1-T2; nine: T3-T4) and ten surgery @entity1 (five: T1-T2; five: T3-T4) available for long-term quality of life assessment. RESULTS: @entity1 treated with radiation had consistently better performance status scores and quality of life according to our study. This was true for those with early ( @entity7279 ) as well as more advanced (T3-4) disease. For eating in public, @entity7279 @entity1 had scores of 85 vs. 75 (p = .31) and T3-4 @entity1 had scores of 82 vs. 35 (p < .0001) for radiation vs. surgery, respectively. For understandability of speech, @entity7279 @entity1 had scores of 92 vs. 65 (p = .0021), and T3-4 @entity1 had scores of 95 vs. 35 (p < .0001) for radiation vs. surgery, respectively. For normalcy of diet, @entity7279 @entity1 had scores of 74 vs. 50 (p = .047), and T3-4 @entity1 had scores of 78 vs. 32 (p = .0012) for radiation vs. surgery, respectively. In addition, we compared scores for early vs. @entity1442 treated by the same modality. For radiation, there was no difference in all three functional categories for @entity7279 vs. T3-4 (p = .84), showing that quality of life scores remain high for all stages. For surgery, functional status deteriorated significantly when comparing @entity7279 vs. T3-4 (p = .0014), consistent with the fact that @entity5 require more extensive operations. CONCLUSION: Radiation therapy provides a better performance status than surgery for @entity5 . This is true for both early and @entity1442 . Because radiation also provides similar local control and survival, our data suggests that radiation may be the preferred strategy. Functional scores remain high for all T stages treated with radiation, but deteriorate with more advanced T stages for @entity1 treated with surgery. Similar studies using objective criteria are needed to further compare these treatments.
