A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311

Ferris, Robert L.; Flamand, Yael; Holsinger, F. Christopher; Weinstein, Gregory S.; Quon, Harry; Mehra, Ranee; García, Joaquín J.; Hinni, Michael L.; Gross, Neil D.; Duvvuri, Umamaheswar; Méndez, Eduardo; Ridge, John A.; Magnuson, J. Scott; Higgins, Kerry A.; Patel, Mihir R.; Smith, Russel B.; Karakla, Daniel W.; Kupferman, Michael E.; Malone, James P.; Judson, Benjamin L.; Richmon, Jeremy D.; Boyle, Jay O.; Bayon, Rodrigo; O’Malley, Bert W.; Özer, Enver; Thomas, Giovana R.; Koch, Wayne M.; Bell, R. Bryan; Saba, Nabil F.; Li, Shuli; Sigurdson, Elin R.; Burtness, Barbara

doi:10.1016/j.oraloncology.2020.104797

Cited by 34 publications

(37 citation statements)

References 26 publications

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“…in Australia, where the Australian Society of Otolaryngology, Head and Neck Surgery defined clear guidelines with a minimum of 20 procedures per year required to be performed by the surgeon to be accredited [ 18 ]. Results from a US study describing a novel credentialing and quality assurance process to support multicenter transoral head and neck oncology trials, showed low incidences of positive margins and grade III/IV bleeding in surgeons with ≥ 20 transoral resection for OPCC [ 22 ]. The presented survey does not allow for evaluation of each respondants/institutions case load, as it was not subject of this study.…”

Section: Discussionmentioning

confidence: 99%

Acceptance and adoption of transoral robotic surgery in Germany

Mandapathil

Meyer

2021

Eur Arch Otorhinolaryngol

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Purpose Since its introduction over a decade ago, the use of robotic surgery (RS) in head and neck surgery has widely spread around the globe, with very differential adoption of this novel surgical technique in different parts of the world. In this study, we analyze the acceptance and adoption of robotic surgery in the head and neck in Germany. Materials and methods A cross-sectional analysis using a questionnaire evaluating the acceptance and adoption of RS was performed. Questionnaires were distributed to all chairmen /-women of Otorhinolaryngology, Head and Neck Surgery Departments in Germany. Results A total of 107 respondents completed the questionnaire (65.2%). At university hospitals, 71.4% of the respondents indicated that a robotic system was available, and 21.4% responded that robotic surgery was performed at their institution; 22.7% and 0.04%, respectively, at non-university hospitals. The overall adoption rate was 0.8%. The most common cases performed were TORS resection in the oropharynx. Main reasons for not adopting this technique were costs, lack of interest and available co-operations. Conclusion This study provides evidence of the extent of adoption of TORS in Germany; main perceived barriers to adoption are costs with lack of cost-covering reimbursement and insufficient co-operations with other disciplines as well as hospital administration resulting in a very low adoption rate of this technique over the past decade. Results from this study may assist in decision-making processes on adopting this technique in the future.

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Section: Discussionmentioning

confidence: 99%

Acceptance and adoption of transoral robotic surgery in Germany

Mandapathil

Meyer

2021

Eur Arch Otorhinolaryngol

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“…The moderate-risk group were randomized and received standard adjuvant dose (60 Gy) radiotherapy reduction therapy (50 Gy). 2 years PFS was similar in the two groups 32 .…”

Section: Hpv Status and Chemoradiotherapymentioning

confidence: 66%

Therapeutic strategies of different HPV status in Head and Neck Squamous Cell Carcinoma

Sun¹,

Wang²,

Qiu³

et al. 2021

Int. J. Biol. Sci.

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Head and neck squamous cell carcinoma (HNSCC) is the 9 th most common malignant tumor in the world. Based on the etiology, HNSCC has two main subtypes: human papillomavirus (HPV)-related and HPV-unrelated. HPV-positive HNSCC is more sensitive to treatment with favorable survival. Due to the different biological behaviors, individual therapy is necessary and urgently required to deduce the therapeutic intensity of HPV-positive disease and look for a more effective and toxicity-acceptable regimen for HPV-negative disease. EGFR amplification and PI3K/AKT/mTOR pathway aberrant activation are quite common in HPV-positive HNSCC. Besides, HPV infection alters immune cell infiltrating in HNSCC and encompasses a diverse and heterogeneous landscape with more immune infiltration. On the other hand, the chance of HPV-negative cancers harboring mutation on the P53 gene is significantly higher than that of HPV-positive disease. This review focuses on the updated preclinical and clinical data of HPV-positive and HPV-negative HNSCC and discusses the therapeutic strategies of different HPV status in HNSCC.

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“…13,14 The rate of positive margins was higher than what is reported in controlled trials such as ECOG 3311. 9 Interestingly, the rate has been declining each year, and it is significantly lower in the most recent year. On the other hand, a significant number of patients were upstaged after surgery with rates of occult nodal metastases (29.1%) consistent with those observed in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…The largest randomized phase II trial (ECOG-3311), examining various treatment modalities for HPV-positive disease, focuses on stage III to IV oropharyngeal cancers only, and no such trials exist in early stage disease. 9 Furthermore, the only study dedicated to HPV-negative oropharyngeal cancer (RTOG 1221) was closed due to lack of accrual. The National Cancer Database (NCDB) began documenting HPV status in 2010, thus affording us an opportunity to analyze the treatment of early stage tonsil cancer while controlling for HPV status.…”

mentioning

confidence: 99%

Treatment of Early Stage Tonsil Cancer in the Age of Human Papillomavirus–Associated Malignancies

Patel

Zhu

Oliver

et al. 2020

Otolaryngol.--head neck surg.

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Objective To investigate the patterns of care and outcomes of treatment of early stage tonsil cancers, controlling for human papillomavirus (HPV) status. Study Design Historical cohort study. Setting National Cancer Database (NCDB). Methods Review of the NCDB between 2010 and 2017 for all T1-2N0M0 tonsillar squamous cell carcinoma (SCC). Demographics, clinical characteristics, HPV status, treatment regimens, and survival were analyzed. Results A total of 4720 patients were identified with early stage SCC of the tonsil. Most were tested for HPV (2759 [58.5%]). Among tested patients, 1758 (63.7%) were positive for HPV and 1001 (36.3%) were negative for HPV. HPV-positive patients had higher 3-year survival compared to HPV-negative patients (93.2% vs 77.8%, P < .001). Among HPV-positive patients, there was no significant difference in survival between treatment cohorts. However, in the HPV-negative cohort, 3-year survival was higher in both bimodality surgical-based settings (tonsillectomy + neck dissection + radiotherapy, 86.0% vs chemoradiotherapy, 69.6%, P = .01) and for all surgical-based treatments when compared to nonsurgical management (84.6% vs 69.3%, P < .001). This difference was maintained in multivariable regression controlling for age, sex, comorbidities, clinical T stage, and treatments. In a subpopulation of HPV-negative patients propensity score matched by all factors significant in multivariable analysis, 3-year survival remained higher in the surgically treated group compared to the nonsurgically treated cohort (84.9% vs 67.1%, P < .001). Conclusions Surgical- or radiation-based treatment resulted in similar survival in early stage HPV-positive tonsil cancer. Surgical-based treatments were associated with longer survival in HPV-negative cancers. These findings should be further investigated in a randomized prospective trial.

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A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311

Cited by 34 publications

References 26 publications

Acceptance and adoption of transoral robotic surgery in Germany

Acceptance and adoption of transoral robotic surgery in Germany

Therapeutic strategies of different HPV status in Head and Neck Squamous Cell Carcinoma

Treatment of Early Stage Tonsil Cancer in the Age of Human Papillomavirus–Associated Malignancies

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