Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation

Autor: C.E. Wooten, Bhaswanth Dhanireddy, Lauren A Shelton, Andrew Shearer, Nicolas P. Burnett, Sreeja Sanampudi, Thomas J. Gal, Jon A. Slezak, Brent J. Shelton, Mahesh Kudrimoti, Susanne M. Arnold
Rok vydání: 2019
Předmět:
Male
medicine.medical_treatment
Kaplan-Meier Estimate
0302 clinical medicine
Robotic Surgical Procedures
Cause of Death
Outcome Assessment
Health Care
Stage (cooking)
030223 otorhinolaryngology
Chemoradiotherapy
Middle Aged
Prognosis
Oropharyngeal Neoplasms
Treatment Outcome
medicine.anatomical_structure
Chemotherapy
Adjuvant
030220 oncology & carcinogenesis
Carcinoma
Squamous Cell
Neck Dissection
Female
Adult
Natural Orifice Endoscopic Surgery
medicine.medical_specialty
Risk Assessment
Disease-Free Survival
03 medical and health sciences
Tongue
Transoral robotic surgery
medicine
Adjuvant therapy
Humans
Neoplasm Invasiveness
Aged
Neoplasm Staging
Retrospective Studies
Mouth
Chemotherapy
business.industry
Cancer
Neck dissection
medicine.disease
Survival Analysis
Surgery
Logistic Models
Otorhinolaryngology
Case-Control Studies
Tonsil
Multivariate Analysis
Radiotherapy
Adjuvant
business
Zdroj: American Journal of Otolaryngology. 40:673-677
ISSN: 0196-0709
Popis: Purpose Optimal treatment strategies for the management of oropharyngeal squamous cell carcinoma (OPSCC) remain unclear. The objective of this study is to examine the role of transoral robotic surgery (TORS) on functional and treatment outcomes. Materials and methods A retrospective review of patients with OPSCC (tonsil/base of tongue) who underwent TORS with neck dissection± adjuvant therapy between January 2011 to December 2016 were compared to a stage matched cohort of patients treated with primary chemoradiation. Demographic, treatment, and outcome data were collected. Results 54 patients received primary chemoradiation and 65 patients (surgical group) received TORS ± adjuvant therapy for clinically staged disease meeting study criteria. 25% (N = 17) were treated with surgery alone. The remainder of the surgical group received postoperative radiation (N = 48), half of which received adjuvant chemotherapy (N = 24) in addition to radiation. 63% (N = 41) of the patients did not have risk factors for chemotherapy. No differences in overall or disease free survival were observed with TORS compared to chemoradiation (p = 0.9), although Charlson Comorbidity Index (CCI) was higher in the surgical group (p = 0.01). The strongest predictor of prolonged gastrostomy tube use was not treatment, but rather co-morbidity (p = 0.03), with no significant differences beyond 12 months. Conclusion Although no significant survival differences were observed across treatment groups, this was maintained despite increased comorbidity index in the surgical patients. Given the ability to de-escalate and/or eliminate adjuvant therapy, particularly in a less healthy population, TORS would appear to be the viable treatment option it has become.
Databáze: OpenAIRE
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