Avoidance of primary site adjuvant radiotherapy following transoral robotic surgery: a cohort study

Abstract

Background: Post-operative radiotherapy (PORT) volumes and dose to target structures likely influence swallowing function and quality of life following transoral robotic surgery (TORS). The aim of this study is to analyse disease control and swallowing outcomes in patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) to determine the impact of omitting the primary site from the PORT treatment volume. Methods: Prospectively collected data from patients that underwent TORS between March 2013 and April 2021 were reviewed. Patients were categorized into three groups: (1) no PORT, (2) PORT to the neck alone or (3) PORT to the primary site and neck. Survival curves were generated according to the Kaplan-Meier method and swallowing was assessed using the Functional Oral Intake Scale, Public Status Scale Head and Neck, MD Anderson Dysphagia Inventory and feeding tube/gastrostomy dependence. Results: A total of 121 patients underwent TORS, of which 103 met inclusion criteria with a median follow up of 2.6 years. No patients developed local recurrence. The 3-year regional control rates were 90%, 100% and 100% for groups 1, 2 and 3, respectively. Disease-specific survival was 97% over the study period. Patients that received PORT to both the primary site and the neck (group 3) had worse swallowing outcomes at 12 months. Conclusion: Following TORS for OPSCC, avoiding PORT to the primary site, in appropriately selected patients, appears to be oncologically safe and is associated with superior swallowing outcomes.

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

“…The recurrence of OPSCC after TORS was analyzed by subsite in 13 studies [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. There was no statistically significant difference in the odds of total recurrence between tonsillar and BOT OPSCC (1.1 [95%CI 0.8–1.5], p = 0.480) ( Figure 4 ).…”

“…As radiotherapy or chemoradiotherapy has been supported for tumors with positive margins [ 76 , 77 ], these treatments may have influenced the nonsignificant differences in locoregional and distant control seen between tonsillar and BOT OPSCC, even though BOT OPSCC had higher rates of positive margins. Only two studies reported differences in adjuvant therapy between subsites, with Fradet et al finding no differences in the rate of adjuvant therapy, whereas Persky et al found that BOT OPSCC underwent more chemoradiation secondary to more positive margins [ 12 , 40 ]. In looking at all the subsites combined, a few studies have endorsed TORS with adjuvant therapy to be superior to TORS alone, particularly when considering locoregional control [ 16 , 38 ].…”

Trends in free flap reconstruction of the head and neck: a single surgeon series of 1027 free tissue transfers

“…Whilst the senior author has never used jejunal flaps, gastro‐omental free flaps were used for early in this series for chemoradiation failures, but in the last 7 years, fasciocutaneous flaps have been used exclusively for laryngopharyngeal reconstruction. In contrast, human papilloma virus induced oropharyngeal cancers are now the most common mucosal cancer 13 . The rising incidence combined with TORS has increased the need for oropharyngeal reconstruction.…”

“…In contrast, human papilloma virus induced oropharyngeal cancers are now the most common mucosal cancer. 13 The rising incidence combined with TORS has increased the need for oropharyngeal reconstruction. Whilst most TORS cases do not require a free flap, ALT and radial forearm flaps have been used to reconstruct both post-radiation recurrences, usually via mandibulotomy, and tonsil cancers that extend into the soft palate, via TORS, to prevent velopharyngeal insufficiency.…”