Current Role of Surgery in the Management of Oropharyngeal Cancer

Abstract

The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d’Oncologie Radiothérapie Tête Cou trial. Since that time, human papillomavirus–associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus–positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.

Long‐term analysis of transorally resected p16 + Oropharynx cancer: Outcomes and prognostic factors

“…40,43 The median (range) adjuvant radiation dose at the primary, ipsilateral, and contralateral neck in our study cohort was 66 (48-70), 66 (36-70), and 56 (45-66) grays (Gy). Treatment deintensification to reduce treatment toxicity while maintaining good oncologic outcomes are underway for both surgical [44][45][46][47] and nonsurgical 48,49 management of HPV-related OPSCC. During our study period, institutional deintensification strategies evolved toward eliminating radiation to the primary site in margin-negative resected T1 to T2 tumors, 50 and to the contralateral neck for well-lateralized tumors, 51 as well as reducing the ipsilateral radiation dose to 60 Gy.…”

Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone

“…Existing treatment protocols for OPSCC were developed prior to HPV status consideration . With recent advancements in transoral surgery (including transoral robotic surgery and transoral laser microsurgery), there are increased efforts to manage HPV + OPSCC with surgery as the primary treatment to avoid or reduce radiation and chemotherapy toxicities . Several studies have demonstrated a better quality of life (QOL) in patients who underwent primary surgery for OPSCC .…”

Risk Factors for Overall Survival Outcome in Surgically Treated Human Papillomavirus-Negative and Positive Patients with Oropharyngeal Cancer

“…However, the surgical patients were often p16 negative and treated before 2000, whereas the nonsurgical group was treated after 2000 with a much larger proportion of p16-positive patients. Several studies, based on single-center or multicenter evaluations of patient outcomes, have shown excellent oncological and functional outcomes with surgery for locally advanced OSCC [26,27]. However, the impact of HPV has not been emphasized in historic samples.…”