A comparison of oncological outcomes between transoral surgical and non-surgical treatment protocols in the management of oropharyngeal squamous cell carcinoma

Kao, Stephen Shih-Teng; Micklem, Jasmine; Ofo, Enyinnaya; Edwards, Suzanne; Dhatrak, D.; Foreman, Andrew; Krishnan, Suren; Hodge, John-Charles

doi:10.1017/s0022215117000986

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…The TOS Arm demonstrated a higher incidence of distant metastases and second primary tumors. Similar trends were also noted by Kao et al 18 …”

Section: Discussionsupporting

confidence: 91%

“…The TOS Arm demonstrated a higher incidence of distant metastases and second primary tumors. Similar trends were also noted by Kao et al 18 We have addressed the issue of adjuvant treatment amounting to triple modality treatment as seen in 10 out of 57 patients who underwent upfront TOS due to increasing identification of adverse features following detailed pathological evaluation. Gildener-Leapman et al in their series identified a 33% rate of tumor upstaging amounting to double and sometimes triple modality treatment.…”

Section: Discussionsupporting

confidence: 68%

“…As seen in our “unadjusted” model, there is a tendency to plan TOS for a limited tumor with smaller nodal burden preferably located near the tonsil with minimal base of tongue involvement. Kao et al 18 showed better OS in the surgical arm compared to nonsurgical arm in OPSCC (5‐year OS: 78% vs. 35%, p < 0.5). This apparent difference with respect to the type of treatment could be attributed to the higher number of HPV‐associated cancers (87% vs. 46%) in the surgical arm and increased prevalence of advanced tumors in the nonsurgical arm (63% vs. 10%).…”

Section: Discussionmentioning

confidence: 96%

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A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

et al. 2021

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Background With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)‐negative oropharyngeal squamous cell carcinoma (OPSCC). Methods Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk‐stratified adjuvant treatment) and Arm II (nonsurgical treatment − radiation/chemoradiation) in HPV(−) OPSCC. Results Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease‐free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5‐year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4‐year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04). Conclusions TOS +/− adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I–III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.

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“…The TOS Arm demonstrated a higher incidence of distant metastases and second primary tumors. Similar trends were also noted by Kao et al 18 …”

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

et al. 2021

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“…These techniques provide a highly magnified view of the tumor, which permits confident resection of the tumor. 33 , 34 …”

Section: Minimally Invasive Surgeriesmentioning

confidence: 99%

Review of surgical resection and reconstruction in head and neck cancer

Alfouzan

2018

SMJ

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This review summarizes the development of head and neck cancer resection and reconstruction. The developments in the treatment of cancer patients are reflected in their surgical outcomes, in addition to functional and aesthetic improvements. New technologies, such as surgical simulation and planning, minimally invasive surgery, and microsurgery have been added to the field to improve surgical resection of the tumor and reconstruction. The field is still growing to optimize the management of head and neck cancer.

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“…Most primary HPV-positive OPSCC cases, however, are successfully treated with surgery or radiation-based therapy [4]. For those that recur, particularly after radiationbased therapy, salvage surgery (SS) is often considered the best-remaining curative treatment option [5,6]. Despite being the best treatment option, SS carries significant morbidity and has been previously reported to have poor survival outcomes for OPSCC in general, but it is not known how the prognosis differs between HPV-positive and HPV-negative cancers [7].…”

Section: Introductionmentioning

confidence: 99%

The Lack of Standardized Outcomes for Surgical Salvage of HPV-Positive Recurrent Oropharyngeal Squamous Cell Carcinoma: A Systematic Scoping Review

Taniguchi

Sutton

Nguyen

et al. 2023

Cancers

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Although HPV status is known to provide an improved prognosis in initial treatments of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), it is unclear how it affects patients who receive salvage surgery (SS), which has historically poor survival rates. The purpose of this study was to evaluate the role of SS for patients with locoregional recurrence (LRR) of HPV-positive OPSCC and its impact survival rates. We conducted a scoping review of literature through October 2022 and included 995 individuals. Survival endpoints, such as overall survival (OS), Kaplan–Meier curves, and median post-recurrence survival, were analyzed in addition to demographics. Of all studies, 18.8% (6/32) reported any survival data for SS patients, with the most prevalent reporting 2- and 5-year OS in two studies. Median post-recurrence survival was not reported for SS. These findings reveal the limited and unpredictable reporting of survival-specific data on SS for HPV-positive OPSCC. With limited survival assessment, it is difficult to assess the potential advantages and disadvantages of this therapy to guide clinical decision-making.

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A comparison of oncological outcomes between transoral surgical and non-surgical treatment protocols in the management of oropharyngeal squamous cell carcinoma

Abstract: This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.

Cited by 5 publications

References 25 publications

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

A matched pair analysis of oncological outcomes in human papillomavirus‐negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation

Review of surgical resection and reconstruction in head and neck cancer

The Lack of Standardized Outcomes for Surgical Salvage of HPV-Positive Recurrent Oropharyngeal Squamous Cell Carcinoma: A Systematic Scoping Review

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