Postoperative Adjuvant Therapy after Transoral Robotic Resection for Oropharyngeal Carcinomas: Rationale and Current Treatment Approach

Abstract

The advancement of transoral surgical techniques for the management of oropharyngeal carcinomas has raised questions about how adjuvant therapy can best be integrated. Some of these questions have come from the application of established oncologic principles of adjuvant therapy, and some are unique to the evolving experience with transoral surgery and in particular with the recent advancement of robotic surgery. It is important for all members of the multidisciplinary treatment team to have a clear understanding of the foundation for adjuvant therapy and the issues unique to transoral robotic surgery to provide optimal patient care as this new treatment paradigm gains popularity for its safe application.

Accuracy of Computed Tomography in the Prediction of Extracapsular Spread of Lymph Node Metastases in Squamous Cell Carcinoma of the Head and Neck

“…Surgery, followed by a shortened course of radiation therapy without chemotherapy, may have fewer late toxic effects than definitive chemoradiotherapy. [33][34][35] However, the treatment decision is partly dependent on accurate pretreatment detection of ECS. Patients with ECS identified after TORS and neck dissection will still require adjuvant chemotherapy and near full-level radiation therapy, attenuating the potential advantages of TORS.…”

Transoral laser microsurgery followed by radiation therapy for oropharyngeal tumors: The mayo clinic arizona experience

“…17 Can we safely exclude the primary site from our radiation field in certain situations, as has been suggested by Quon et al? 18 We have previously reported on 69 patients with oropharyngeal cancer that were treated with TLM alone. 19 Forty-four of the 69 patients were stage III or IV and there were only 3 local recurrences.…”

Transoral Robotic Surgery Alone for Oropharyngeal Cancer

“…In the case of relative indications for adjuvant treatment, the risks and benefits of treatment vs observation are discussed in detail with the patient. Quon et al 8 have previously described the rationale and approach for postoperative irradiation following TORS.…”