Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer

Sethia, Rishabh; Yumuşakhuylu, Ali Cemal; Özbay, İsa; Diavolitsis, V.M.; Brown, Nicole V.; Zhao, Songzhu; Wei, Lai; Old, Matthew; Agrawal, Amit; Teknos, Theodoros N.; Özer, Enver

doi:10.1002/lary.26796

Cited by 83 publications

(87 citation statements)

References 22 publications

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“…There is a growing body of literature supporting the use of TORS as a minimally invasive treatment option with greater preservation of swallowing function and long‐term QOL compared to primary RT/CRT . When considering these QOL assumptions, TORS has also been described as a more cost‐effective treatment option in recent formal cost‐effectiveness analyses .…”

Section: Discussionmentioning

confidence: 99%

“…In the first study, by directly comparing QOL outcomes in patients receiving TORS alone vs TORS with adjuvant RT or CRT, Sethia et al found that the TORS alone group reported higher overall QOL across eating, social, and speech domains through 6 months after treatment . However, at 12 months, there were no longer significant differences in these outcomes in their prospective cohort of 111 patients . However, patients typically receive lower doses when treated with adjuvant therapy compared to primary RT/CRT, potentially resulting in decreased toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a review of 70 patients with advanced head and neck cancer reported a prevalence of opioid use of 66% at 3 months following completion of primary chemoradiation therapy (CRT) . Although the quality of life (QOL) and functional benefits of transoral robotic surgery (TORS) have been well‐described recently, we are not aware of any studies that have investigated the prevalence of chronic opioid use in patients with early T classification oropharyngeal cancer or the effect of treatment modality on this outcome. Therefore, the aim of this study was to determine the impact of treatment modality on the prevalence of chronic opioid use in patients with T1 and T2 oropharyngeal cancer as well as identify other potential risk factors in this population.…”

Section: Introductionmentioning

confidence: 99%

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Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Bollig

Jorgensen

2019

Head & Neck

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Background The effect of treatment modality on long‐term opioid dependence in patients with oropharyngeal cancer has not been reported. Methods A retrospective cohort of 122 patients with T1/T2 oropharyngeal cancer undergoing treatment was generated. Risk factors associated with chronic opioid use were investigated by univariate and multivariate analyses. Results The prevalence of chronic opioid use was 45.9%. On multivariate analysis, primary nonsurgical treatment (odds ratio [OR] 4.5, 95% confidence interval [CI]: 1.7‐11.4), pretreatment opioid use (OR 14.9, 95% CI: 3.5‐62.5), psychiatric disorder (OR 4.3, 95% CI: 1.03‐18.5), alcohol use (OR 2.6, 95% CI: 1.03‐6.5), and younger age (OR 1.1, 95% CI: 1.02‐1.11) were significantly associated with chronic opioid use. Conclusion Primary nonsurgical treatment, younger age, pretreatment opioid use, alcohol use, and psychiatric disorder were independently associated with an increased risk of chronic opioid use. Preventative strategies should be especially focused toward these patients to reduce their risk of long‐term opioid use.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Bollig

Jorgensen

2019

Head & Neck

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“…PSS domains of poorer speech understandability and ability to eat in public have also been observed in patients with adjuvant treatment, with the poorest functioning occurring in those with adjuvant chemoradiotherapy . Others found poorer QOL in patients undergoing adjuvant treatment as compared to TORS surgery alone, with the poorest QOL found with adjuvant chemoradiotherapy …”

Section: Discussionmentioning

confidence: 99%

“…Further, although time to oral diet, diet type, and need for percutaneous endoscopic gastrostomy (PEG) placement have been examined in patients undergoing TORS, no studies have measured swallow functioning in terms of safety and efficiency after TORS procedures. Finally, many of these studies include evaluation of patients after adjuvant therapy and do not assess the functional impact of TORS alone on swallowing …”

Section: Introductionmentioning

confidence: 99%

Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy

Lazarus

Ganz

et al. 2018

Head & Neck

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Background Transoral robotic surgery (TORS) has been utilized to deintensify treatment. No studies have measured swallow safety and efficiency, nor assessed the functional impact of TORS alone. Methods This prospective cohort underwent baseline and 1‐month postsurgery assessments including modified barium swallow evaluation, using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) rating system, tongue range of motion assessment, the Performance Status Scale (PSS), and quality of life with the MD Anderson Dysphagia Inventory (MDADI). Results All DIGEST safety scores were 0 (normal) at both time points. DIGEST efficiency scores were mildly impaired in 2 of 10 patients postsurgery. PSS scores revealed all patients were on regular diets, were 100% understandable, and were eating in public at both time points. Tongue Range of Motion scores were 100 of 100 at both time points. MDADI scores were not significantly different across time points. Conclusions Careful identification of patients can result in excellent outcomes following TORS. Future studies will examine longer follow‐up of speech, swallowing, and tongue function in patients undergoing TORS surgery.

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Risk of Pathologic Extranodal Extension and Other Adverse Features After Transoral Robotic Surgery in Patients With HPV-Positive Oropharynx Cancer

Zebolsky

George

Gulati

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEUnderstanding patient-specific risk of adverse histopathologic findings after primary surgery for human papillomavirus (HPV)-positive oropharynx squamous cell carcinoma (OPSCC) may help guide patient consultations.OBJECTIVE To determine the likelihood of adverse histopathologic features that may indicate adjuvant radiotherapy or chemoradiotherapy after primary surgery for HPV-positive OPSCC according to 2021 National Comprehensive Cancer Network guidelines. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was performed at a single academic tertiary care center. Of 258 patients who underwent transoral robotic surgery (TORS) from March 1, 2012, to March 1, 2021, 136 consecutive, treatment-naive patients with HPV-positive OPSCC without obvious clinical extranodal extension (ENE) who underwent definitive TORS and neck dissection were included in the analysis. Indications for surgical treatment included non-deeply infiltrative oropharynx tumors, minimal soft palate involvement, and low suspicion for pathologic ENE.EXPOSURES Primary site TORS with neck dissection. MAIN OUTCOMES AND MEASURESThe primary outcomes were the adverse histopathologic features of pathologic ENE and positive surgical margins (PSM) that are indications for possible adjuvant chemoradiotherapy. Outcomes were compared among varying American Joint Committee on Cancer 7th edition (AJCC-7) T and N categories and patient clinical characteristics. RESULTSOf the 136 patients included in the analysis (113 men [83.1%]; median age, 63 [interquartile range, 55-70] years), 109 (80.1%) had at least 1 indication for possible adjuvant radiotherapy. Twenty-seven patients (19.9%) had pathologic ENE and 10 (7.3%) had PSM. Thirty-four patients (25.0%) had pathologic ENE and/or PSM, whereas 3 (2.2%) had both. Age, smoking history, history of alcohol consumption, and clinical T category were not associated with pathologic ENE, PSM, lymphovascular invasion, perineural invasion, or pN2 category or greater. The proportion of pathologic ENE varied by clinical N category: 0 of 16 for cN0, 8 of 48 (16.7%) for cN1, 3 of 23 (13.0%) for cN2a, and 16 of 45 (35.6%) for cN2b. Compared with patients with cN1-cN2a disease, patients with cN2b disease had higher odds of pathologic ENE (odds ratio, 3.01; 95% CI, 1.14-8.10). Clinical and pathologic N category were concordant in 77 patients (56.6%), whereas 42 (30.9%) were upstaged and 17 (12.5%) were downstaged. CONCLUSIONS AND RELEVANCEIn this cohort study, approximately one-quarter of carefully selected patients with HPV-positive OPSCC without obvious clinical ENE undergoing primary surgery had pathologic ENE and/or PSM. Patients with AJCC-7 cT0-cT2 cN0-cN2b disease, especially cN0-cN2a, without signs of clinical ENE may represent appropriate candidates for primary surgery when avoidance of adjuvant chemotherapy and/or reduction of adjuvant radiotherapy dose/extent are the goals.

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Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer

Abstract: 4. Laryngoscope, 128:403-411, 2018.

Cited by 83 publications

References 22 publications

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy

Risk of Pathologic Extranodal Extension and Other Adverse Features After Transoral Robotic Surgery in Patients With HPV-Positive Oropharynx Cancer

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