Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit?

Abstract

Background With increasing adoption of transoral robotic surgery (TORS) for oropharyngeal cancer (OPC), more patients may receive trimodality therapy. We sought to investigate outcomes and toxicities in this cohort. Methods A retrospective study of patients with OPC treated with trimodality therapy at a tertiary‐care hospital, comparing those receiving bilateral vs unilateral neck radiation. Results Four hundred thirty‐six patients underwent TORS, 17% receiving adjuvant chemoradiation. Of the 46 patients completing adjuvant treatment in‐house, contralateral neck was spared in 20%. There were no significant differences in survival, and patient‐reported outcomes in salivary function, mood, and anxiety were superior in those patients receiving unilateral neck radiation and directly correlated with mean dose to local structures. Conclusions Surgery for OPC offers the potential for reduction in radiation volumes by omitting the contralateral neck in those who may have required definitive chemoradiation. Even in patients receiving concurrent chemotherapy, unilateral neck radiation has a favorable toxicity profile without compromising survival.

Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma of the Tonsil versus Base of Tongue: A Systematic Review and Meta-Analysis

“…A total of 12 studies included extractable data on margin status after resection using TORS [ 12 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. BOT OPSCC had a statistically significant higher rate of positive margins when compared to tonsillar OPSCC (28.1% [95% CI 15.1–43.3] vs. 7.5% [95% CI 3.3–13.3]).…”

Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer centre

“…In their 4-year-long surgical series (2014-2018), Huang et al reported that 70% of patients had received adjuvant treatment, and concurrent chemoradiation in almost half of cases 5 . Other authors showed that upfront TOS proved successful in sparing RT in 9-27% of cases and CRT in 34-45% 34,39,40 . Our results agree with literature data, since about 30% of patients were treated with surgery only, because of the lack of pathological risk factors.…”

Survival and toxicity in patients with human papilloma virus‐associated oropharyngeal squamous cell cancer receiving trimodality therapy including transoral robotic surgery

“…Several series have shown that TORS followed by adjuvant (chemo)radiotherapy is associated with inferior quality of life compared to TORS alone 22,23 ; furthermore, a small retrospective series showed that patients with locally advanced oropharyngeal carcinoma treated with TMT including TORS had worse functional outcomes than patients treated with definitive chemoradiotherapy 24 . Most of the evidence for excess toxicity associated with TMT, however, is derived from series that included nonrobotic surgery and/or enrolled patients with HPV‐negative cancers, the latter of which often have more comorbid conditions and are consequently more vulnerable to treatment‐related toxicity 25–29 . To date, there have been no series describing outcomes specifically in patients with HPV + OPSCC who undergo TORS and TMT.…”

“…24 Most of the evidence for excess toxicity associated with TMT, however, is derived from series that included nonrobotic surgery and/or enrolled patients with HPV-negative cancers, the latter of which often have more comorbid conditions and are consequently more vulnerable to treatment-related toxicity. [25][26][27][28][29] To date, there have been no series describing outcomes specifically in patients with HPV + OPSCC who undergo TORS and TMT. In this study, we summarize survival outcomes and toxicity in a cohort of patients with HPV + OPSCC who received TMT at a tertiary academic medical center performing a high volume of TORS.…”