Transoral robotic surgery with neck dissection versus <scp>nonsurgical</scp> treatment in stage I and <scp>II</scp> human papillomavirus<scp>‐negative</scp> oropharyngeal cancer

Bollig, Craig A.; Morris, Brian J.; Stubbs, Vanessa C.

doi:10.1002/hed.27045

Cited by 7 publications

(4 citation statements)

References 38 publications

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“…Therefore, it is necessary to use nebulizer therapy for patients suffering from viscous sputum and expectoration difficulty. Besides, margin status has been demonstrated to be an important prognostic factor, especially in HPV‐negative OPSCC, the positive rate of surgical margin was more easily obtained, up to 17.3% 36–38 . In our series, only three patients have carcinoma in situ in the postoperative pathological analysis.…”

Section: Discussionmentioning

confidence: 52%

“…Besides, margin status has been demonstrated to be an important prognostic factor, especially in HPV-negative OPSCC, the positive rate of surgical margin was more easily obtained, up to 17.3%. [36][37][38] In our series, only three patients have carcinoma in situ in the postoperative pathological analysis. Reports showed that HPVnegative OPSCCs located at the base of the tongue are more likely to have positive surgical margins in TORS.…”

Section: Follow-up and Survival Outcomesmentioning

confidence: 71%

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Analysis of T1‐T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery

Zhang

Chen

et al. 2023

Laryngoscope Investig Oto

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Objective: Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China.Methods: Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed.Results: A total of 83 patients (HPV-positive, n = 25; HPV-negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% (P = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P < .05). Conclusion:Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status.

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Section: Discussionmentioning

confidence: 52%

Section: Follow-up and Survival Outcomesmentioning

confidence: 71%

Analysis of T1‐T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery

Zhang

Chen

et al. 2023

Laryngoscope Investig Oto

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“…Our results compared favourably with other studies demonstrating a low positive margin rate of 10.9%. There was a signi cant range in the variability of margin status in the literature ranging from 4-20%[13, 14,25]. In our study, patients with positive margins were more likely to have both locoregional and metastatic disease recurrence.…”

Section: Discussionmentioning

confidence: 54%

Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single- center retrospective Australian study

Kornfeld,

Taha,

Kyang

et al. 2024

Preprint

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Background We present a cohort review of TORS resection for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) and its associated oncological outcomes spanning a 10-year period. Methods A retrospective case series review was performed of patients undergoing primary surgical treatment for HPV-associated OPSCC through the St. Vincent’s Head and Neck Cancer service from 2011–2022. The primary outcomes were to investigate complete resection of the primary tumour, rates of recurrence, and survival analysis. Secondary outcomes included complications, rates of adjuvant therapy, sites of recurrence and rates of percutaneous endoscopic gastrostomy (PEG). Results 184 patients underwent TORS-based therapy with neck dissection, and guideline directed adjuvant therapy for HPV-associated OPSCC. Our median follow up was 46 months. The positive margin rate on final histopathology analysis was 10.9%. Adjuvant therapy was indicated in 85 patients (46%). The local recurrence rate was 10.9% with the majority (80%) of patients recurring in the first 3 years since treatment. The disease-specific survival at 3 years was 98.6% and at 5 years was 94.4%. The 3-year and 5-year OS for the cohort was 96.7% and 92.5% respectively. Presence of extranodal extension and positive margins were associated with increased risk of recurrence, whereas adjuvant therapy was found to be a protective factor for both overall recurrence and survival. Major complications occurred in 12 patients (6.5%), resulting in one death. Conclusion This study has demonstrated that primary surgical therapy for HPV-associated OPSCC is a safe and effective treatment modality with low local recurrence and complication rates, and overall survival benefits.

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“…However, multiple modality therapy increases risk for treatment-related morbidity. Further, for early-stage HPV-negative oropharyngeal SCC, surgery may offer improved outcomes over chemoradiation, given reduced efficacy of non-surgical therapies ( 69 ). Similar concepts may be translatable to HPV-negative SCCUP and such trials investigating treatment options for HPV-negative are needed.…”

Section: Discussionmentioning

confidence: 99%

Updates in the management of unknown primary of the head and neck

et al. 2022

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Squamous cell carcinoma (SCC) from an unknown primary tumor (SCCUP) accounts for 2.0%–5.0% of all head and neck cancers. SCCUP presents as enlarged cervical lymph nodes without evidence of a primary tumor upon physical examination. Primary site detection is important to target treatment and avoid treatment-related morbidity. In this review, we discuss updates in SCCUP management. Diagnostic workup should focus on localization of the primary tumor in SCCUP. Initial workup centers on neck biopsy to confirm the presence of SCC. Given the increasing incidence of HPV-related SCC in the oropharynx, HPV testing is crucial. An HPV-positive status can localize the tumor to the oropharynx, a common site for occult tumors. Imaging includes neck CT and/or MRI, and PET/CT. After imaging, panendoscopy, palatine tonsillectomy or diagnostic transoral robotic surgery can facilitate high rates of primary tumor localization. Primary tumor localization influences treatments administered. SCCUP has traditionally been treated aggressively with large treatment fields to all potential disease sites, which can induce weight loss and swallowing dysfunction. As a result, primary localization can reduce radiation fields and provide possible de-escalation to primary surgical management. Advances in intensity-modulated radiation therapy and dose management also have the potential to improve functional outcomes in SCCUP patients. Given the improved prognosis associated with HPV-positive SCCs, HPV tumor status may also inform future treatment de-intensification to reduce treatment-related toxicity.

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Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

Cited by 7 publications

References 38 publications

Analysis of T1‐T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery

Analysis of T1‐T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery

Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single- center retrospective Australian study

Updates in the management of unknown primary of the head and neck

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