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

Abstract

Background The purpose of this study was to report the treatment outcomes of patients with advanced oropharyngeal cancer treated with transoral laser microsurgery (TLM) followed by radiation therapy (RT) at Mayo Clinic in Arizona. Methods A retrospective study of 80 patients treated from January 1, 2000 to November 7, 2011 was performed. All patients had stage III/IV oropharyngeal tumors and underwent TLM with neck dissection. Adjuvant RT was then given. Thirty-seven patients received concurrent adjuvant chemotherapy. The primary outcome was locoregional control. Results Median follow-up was 47.3 months (range, 9.7–139.2 months). The 3-year locoregional control, recurrence-free survival, and overall survival rates were 98.6% (95% confidence interval [CI], 91% to 100%), 91.1% (95% CI, 81% to 96%), and 93.7% (95% CI, 84% to 98%), respectively. There were a total of 5 treatment failures, 1 regional and 4 distant. Twenty-six patients underwent neck only RT with exclusion of the primary site. Conclusion TLM followed by RT for advanced oropharyngeal cancer results in excellent locoregional control rates.

Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach

“…To this end, there is an ongoing effort in our department to incorporate routine measurement of an array of both subjective and objective swallowing evaluations as part of our standard minimum dataset. Congruous results have also been observed in previous TLM series with similarly high rates of HPV positivity in which only a minority of patients were treated with adjuvant CRT, 9,13,[30][31][32][33] albeit a greater proportion than in the present series. 40,41 In a nonrandomized, case-matched study of patients treated for advanced oropharyngeal SCC with either CRT or TLM, O'Hara et al 40 observed significantly better swallowing scores for the TLM cohort at 3 months after treatment, as assessed with patient-reported outcomes using the MD Anderson Dysphagia Inventory, clinicianrated dietary texture restrictions using the Normalcy of Diet scale, and objective swallow performance using the timed Water Swallow Test.…”

“…31 Similar oncological outcomes have been reported in three US single-center series, 13,32,33 with particularly propitious results reported in a recent appraisal of 80 patients with advanced oropharyngeal SCC, albeit predominantly low T classification, from the Mayo Clinic Arizona: respective 3-year locoregional control, DFS, and OS estimates were 98.6%, 91.1%, and 93.7%, respectively. For our study cohort as a whole, 81.0% of which comprised stage III or IV disease, we observed a 3-year locoregional control rate of 89.6% and, respective, 3-year OS, DSS, and DFS rates of 84.5%, 91.7%, and 78.2%, which, although challenging to compare with the oncologic outcomes from previous contemporary surgical series owing to varying distributions of disease stage, HPV status, and adjuvant therapy strategy, seem broadly consistent.…”

“…Indeed, the belief that "organ-preserving" primary nonsurgical treatment regimens offered favorable functional outcomes in comparison with traditional en bloc surgical approaches was a principal motivating factor in the widespread shift toward primary nonsurgical management of SCCHN, oropharyngeal SCC included. 13,32,33 Unfortunately, although such favorable G-tube dependency rates are compelling, our series, and indeed the previous TLM series, lack more comprehensive data regarding swallowing function pretreatment and posttreatment, and, more importantly, lack a direct comparator group treated nonsurgically to allow for a more robust analysis of swallowing outcomes. 11,[15][16][17][18][19][20][21][22][23][24][25] Although, when assessing swallowing function there is no universally recognized single method of measuring outcome, 38 it is apparent that primary CRT regimes often necessitate protracted or permanent nonoral feeding, with high rates of G-tube dependency reported -a crude but objective measure of swallowing outcome.…”

The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients

“…The majority of patients (73%) had adjuvant therapy. Other authors have also confirmed excellent survival following TLM of OPSCCA, with 2‐year DSS over 90% . The frequent presence of nodal metastases results in advanced stage (III or IV) in the majority of patients, and often results in the adjuvant delivery of chemotherapy and radiation to these patients as well as the initial surgery.…”

Letter to the Editor regarding transoral laser microsurgery followed by radiotherapy in advanced oropharyngeal cancer

“…Patel and colleagues 1 are to be congratulated for demonstrating excellent outcomes in their patients treated with TLM and adjuvant therapy. However, it is important to stress that the conclusion should have read “TLM followed by RT for selected patients with advanced oropharyngeal cancer results in excellent control rates”, as this retrospective study has clear selection bias.…”