Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal cancer

Abstract

Objectives/Hypothesis Document survival, prognostic variables, and functional outcomes of patients with AJCC stage III or IV oropharyngeal cancer, treated with transoral laser microsurgery (TLM) ± adjuvant therapy. Study Design Analysis of prospectively assembled data pertaining to the above-described patient cohort. Methods Patients treated with TLM for AJCC stage III or IV oropharyngeal cancer at Washington University School of Medicine from 1996 to 2006 were followed for a minimum of 2 years. Recurrence, survival, functional, and human papilloma virus data were analyzed. Results Eighty-four patients met inclusion criteria. Mean follow-up was 52.6 months. Overall AJCC stages were: III 15% and IV 85%. T stages were T1–2, 74%; T3–4, 26%. Eighty-three patients underwent neck dissection, 50 received adjuvant radiotherapy, and 28 received adjuvant chemoradiotherapy. Overall survival at 2 and 5 years was 94% and 88%, respectively. Disease-specific survival at 2 and 5 years was 96% and 92%, respectively. Six patients recurred (7%): locally (one), regionally (four), and distant (five). T stage, positive margins, and p16 status significantly impacted survival. The addition of adjuvant chemo-therapy in high-risk patients did not significantly impact survival. Five patients (6%) had major surgical complications, but without mortality. Eighty-one percent of patients had acceptable swallowing function at last follow-up. Immediately postoperatively, 17% required G-tubes, which dropped to 3.4% of living patients at 3 years. Conclusions In this population, our findings validate TLM ± adjuvant therapy as a highly effective strategy for survival, locoregional control, and swallowing recovery in AJCC stage III and IV oropharyngeal cancer. Our finding also show that p16 positivity improves survival.

Prognostic value of p16 expression and alcohol consumption in Japanese patients with oropharyngeal squamous cell carcinoma

“…1,2,4 In US and European studies, OPSCC tumors were HPV-positive and p16-positive, were genetically less complex, 16 responded well to all standard types of treatment (including radiotherapy, 10 surgery, 17 and chemotherapy 18 ), and were associated with favorable clinical outcomes. Similarly, the patients with p16-positive OPSCC in the current study had a significantly better prognosis after radiotherapy and tended to have a better prognosis after surgery and chemoradiotherapy.…”

The Role for Surgical Management of HPV-Related Oropharyngeal Carcinoma

“…Steiner expanded the role of transoral resection and popularized transoral laser microsurgery (TLM) for oncologic resection of upper aerodigestive tumors [15]. Steiner's work was subsequently supported by other authors including investigators at Washington University and The Mayo Clinic [16,17]. Haughey et al [18] published a prospective multicenter study of 204 patients with stage III and IV tonsil and tongue base cancer treated primarily with TLM.…”

Partial p16 staining in oropharyngeal squamous cell carcinoma: extent and pattern correlate with human papillomavirus RNA status

“…3,7 The tumors are more common in Caucasian men who are younger than typical head and neck squamous cell carcinoma patients, have less exposure to cigarette smoke, and have higher numbers of sex partners, and greater oral sex exposure than non-HPV-related cancer patients. 5,8,9 They frequently present with large neck masses with small, or even frequently clinically undetectable, primary tumors 1,10,11 that tend to have a non-keratinizing morphology, 12 and that are genetically less complex than non-HPV-related squamous cell carcinomas. Specifically, tumors have less gross chromosomal aberrations, rarely harbor p53 mutations, 13 and have approximately one half the mutation rate of non-HPV-related squamous cell carcinoma.…”