Comparing swallowing function in oral tongue squamous cell carcinoma after upfront brachytherapy followed by IMRT vs. surgery

Purpose
While both surgery and brachytherapy are treatment options for oral tongue squamous cell carcinoma (OTSCC), the impact of surgery vs. brachytherapy on the swallowing function remains inadequately explored. Therefore, we aimed to analyse the differential impacts of surgery and brachytherapy on swallowing outcomes among OTSCC patients.

Material and methods
This cross-sectional study enrolled 30 histologically confirmed OTSCC patients – 14 in the brachytherapy group (HyBIRT) and 16 in the surgery group (SG) – between June 2022 and October 2023. Patients were enrolled only if imaging confirmed a radiological complete response and they remained disease-free for at least 6 months after treatment. Swallowing was assessed using the Swallowing Capacity Scale (SCS), the Malay Eating Assessment Tool-10 (Malay EAT-10), and the Penetration-Aspiration Scale (PAS).

Results
The Swallowing Capacity Scale showed that the patients in the HyBIRT had a superior swallowing capacity, with a mean score of 6.5 compared to the SG (mean score of 4.7). The difference between the two groups was significant (p < 0.01). In the Malay EAT-10 score, the HyBIRT reported a better median score of 5, which contrasted significantly with the surgical group’s median of 22. The p-value < 0.01 was considered significant. Similarly, for the Penetration-Aspiration Scale, where both liquid and semisolid boluses were used, HyBIRT (median score 1) consistently outperformed the SG (median score 2). This result had a p-value of 0.02, which confirmed its statistical significance.

Conclusions
The organ-preserving HyBIRT technique is a promising alternative for managing OTSCC, particularly in preserving swallowing function, and should be further explored in larger, stratified studies with longer follow-up periods to validate these findings.