Transoral laser microsurgery for the treatment of oropharyngeal cancer: The Dalhousie University experience

Abstract

ObjectiveThe optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas.MethodsAll patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM.ResultsBetween 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72 %) patients had primary carcinoma, nine (23 %) were radiation/chemoradiation (RT/CRT) failures, and two (5 %) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88 %) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5 % (SE 10.6 %), 85.7 % (SE 13.2 %) and 77.7 % (SE 12.5 %) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76 % (SE 15.7 %) for LC and 55.6 % (SE 16.6 %) for DSS and DFS. Three patients developed complications following surgery.ConclusionsObserved 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.

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

“…Transoral surgery, including TLM and TORS, has been associated with better survival for OPSCC . However, long‐term outcomes specific to transorally treated p16‐positive OPSCC are lacking or come from studies with a small number of patients. To our knowledge, no primary transoral studies with both oncologic and functional endpoints are published with minimum 5‐year follow‐up of living patients; most report outcomes after a minimum follow‐up of 12 to 24 months or less .…”

“…Melong et al reported DSS and DFS of 86% and 78% in a cohort of 39 TLM‐treated OPSCC patients (23 p16‐positive) followed for 36 months. The survival outcomes were not stratified by p16 status, and about 30% of the cohort were postchemoradiation failure recurrences or second primaries . Recurrence occurred in two (9%) patients with HPV‐positive OPSCC .…”

“…The survival outcomes were not stratified by p16 status, and about 30% of the cohort were postchemoradiation failure recurrences or second primaries . Recurrence occurred in two (9%) patients with HPV‐positive OPSCC . Dale et al evaluated 41 surgically treated HPV‐positive OPSCC and observed 5‐year OS and DSS estimates of 85% and 91%, respectively, at a mean follow‐up of 59.5 months (minimum–maximum, 0–168) .…”

Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption

“…Another minimally invasive surgical technique that has emerged as a promising treatment modality in oropharyngeal cancers is transoral laser microsurgery (TLM). Single‐institution studies seem to indicate that TLM may be effective at obtaining negative margins and maintaining survival, even in advanced stage cancers . The common thought is that TLM allows the surgeon to resect in multiple plans, reducing the amount of normal tissue removed .…”

Timing of neck dissection in association with transoral surgery: A systematic review

“…The initial literature review identified 112 articles of which only 26 met our inclusion criteria see Figure . Tables to summarize these studies.…”