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Long-term survival outcomes in patients with surgically treated oropharyngeal cancer and defined human papilloma virus status. J Laryngol Otol 2016; 130:1048-1053. [DOI: 10.1017/s0022215116009099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:This study investigated long-term survival outcomes in surgically treated oropharyngeal cancer patients with known human papilloma virus status.Methods:A case note review was performed of all patients undergoing primary surgery for oropharyngeal cancer in a single centre over a 10-year period. Human papilloma virus status was determined via dual modality testing. Associations between clinicopathological variables and survival were identified using a log-rank test.Results:Of the 107 cases in the study, 40 per cent (n = 41) were human papilloma virus positive. The positive and negative predictive values of p16 immunohistochemistry for human papilloma virus status were 57 per cent and 100 per cent, respectively. At a mean follow up of 59.5 months, 5-year overall and disease-specific survival estimates were 78 per cent and 69 per cent, respectively. Human papilloma virus status (p = 0.014), smoking status (p = 0.021) and tumour stage (p = 0.03) were significant prognostic indicators.Conclusion:The long-term survival rates in surgically treated oropharyngeal cancer patients were comparable to other studies. Variables including human papilloma virus status and tumour stage were associated with survival in patients treated with primary surgery; however, nodal stage and presence of extracapsular spread were non-prognostic.
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202
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Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
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Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
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Blanchard P, Volk RJ, Ringash J, Peterson SK, Hutcheson KA, Frank SJ. Assessing head and neck cancer patient preferences and expectations: A systematic review. Oral Oncol 2016; 62:44-53. [DOI: 10.1016/j.oraloncology.2016.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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Mattheis S, Hasskamp P, Holtmann L, Schäfer C, Geisthoff U, Dominas N, Lang S. Flex Robotic System in transoral robotic surgery: The first 40 patients. Head Neck 2016; 39:471-475. [PMID: 27792258 DOI: 10.1002/hed.24611] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/05/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The Flex Robotic System is a new robotic device specifically developed for transoral robotic surgery (TORS). METHODS We performed a prospective clinical study, assessing the safety and efficacy of the Medrobotics Flex Robotic System. A total of 40 patients required a surgical procedure for benign lesions (n = 30) or T1 and T2 carcinomas (n = 10). Access and visualization of different anatomic subsites were individually graded by the surgeon. Setup times, access and visualization times, surgical results, as well as adverse events were documented intraoperatively. RESULTS The lesions could be exposed and visualized properly in 38 patients (95%) who went on to have a surgical procedure performed with the Flex Robotic System, which were intraoperatively evaluated as successful. No serious adverse events occurred. CONCLUSION Lesions in the oropharynx, hypopharynx, or supraglottic larynx could be successfully resected using the Flex Robotic System, thus making the system a safe and effective tool in transoral robotic surgery. © 2016 Wiley Periodicals, Inc. Head Neck 39: 471-475, 2017.
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Affiliation(s)
- Stefan Mattheis
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Pia Hasskamp
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Laura Holtmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Christina Schäfer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Urban Geisthoff
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Nina Dominas
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Stephan Lang
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
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205
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Lang S, Mattheis S, Hasskamp P, Lawson G, Güldner C, Mandapathil M, Schuler P, Hoffmann T, Scheithauer M, Remacle M. A european multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope 2016; 127:391-395. [PMID: 27783427 DOI: 10.1002/lary.26358] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/06/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the application of the Flex Robotic System in transoral robotic surgery (TORS). STUDY DESIGN Multicenter, prospective, open-label, single-armed clinical study. METHODS A prospective clinical follow-up multicenter study was performed from July 2014 to October 2015 assessing the safety and efficacy of the Medrobotics Flex Robotic System for access and visualization of the oropharynx, hypopharynx, and larynx as well as for resection of benign and malignant lesions. A total of 80 patients were enrolled. Access and visualization of five anatomic subsites (base of tongue, palatine tonsil area, epiglottis, posterior pharyngeal wall, and false vocal cords) were individually graded by the surgeon. Setup times, access and visualization times, surgical results, and adverse events were documented. RESULTS The relevant anatomic structures could be exposed and visualized properly in 75 patients, who went on to have a surgical procedure performed with the Flex Robotic System. Access and visualization of the palatine tonsil area, posterior pharyngeal wall, epiglottis, and posterior pharyngeal wall were excellent. However, false vocal cords and vocal cords were more difficult to expose. Seventy-two patients were treated successfully with the Flex Robotic System. There were no serious or unanticipated device-related adverse events caused by the Flex Robotic System. CONCLUSIONS Lesions in the oropharynx, hypopharynx, and larynx could be successfully resected with the Flex Robotic System, specifically developed for TORS. Our study provides evidence that the Flex Robotic System is a safe and effective tool in TORS. Laryngoscope, 2016 127:391-395, 2017.
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Affiliation(s)
- Stephan Lang
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Pia Hasskamp
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Georges Lawson
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mont-Godinne, Yvoir, Belgium
| | - Christian Güldner
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
| | - Magis Mandapathil
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
| | - Patrick Schuler
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ulm, Ulm, Germany
| | - Thomas Hoffmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ulm, Ulm, Germany
| | - Marc Scheithauer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ulm, Ulm, Germany
| | - Marc Remacle
- Department of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Belgium
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Does elimination of planned postoperative radiation to the primary bed in p16-positive, transorally-resected oropharyngeal carcinoma associate with poorer outcomes? Oral Oncol 2016; 61:127-34. [DOI: 10.1016/j.oraloncology.2016.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 12/18/2022]
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208
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Sload R, Silver N, Jawad BA, Gross ND. The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma. Curr Oncol Rep 2016; 18:53. [DOI: 10.1007/s11912-016-0541-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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209
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King EV, Harrington K. Future perspectives: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130:S222-S224. [PMID: 27841138 PMCID: PMC4873933 DOI: 10.1017/s0022215116000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The multidisciplinary management of head and cancer has changed radically in the last decade. This paper provides a glimpse of the emerging surgical and oncological interventions that may play major roles in the treatment paradigms of tomorrow.
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Affiliation(s)
- E V King
- Consultant Head and Neck Surgeon Poole Hospital NHS Foundation Trust and University of Southampton, Southampton, UK
| | - K Harrington
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
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210
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Saito Y, Ando M, Omura G, Yasuhara K, Yoshida M, Takahashi W, Yamasoba T. Induction Chemotherapy for p16 Positive Oropharyngeal Squamous Cell Carcinoma. Laryngoscope Investig Otolaryngol 2016; 1:28-32. [PMID: 28894801 PMCID: PMC5527349 DOI: 10.1002/lio2.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/05/2016] [Accepted: 02/20/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives/Hypothesis We aimed to determine the effectiveness of induction chemotherapy for treating p16‐positive oropharyngeal cancer in our department. Study Design This was a retrospective case series to assess treatment effectiveness. Methods We administered induction chemotherapy to patients with stage III to IV oropharyngeal p16‐positive squamous cell carcinoma between 2008 and 2013. Induction chemotherapy was administered using combinations of docetaxel, cisplatin, and 5‐fluorouracil. We measured the survival rates using the Kaplan‐Meier method and log‐rank test. Results We reviewed 23 patients (18 men and 5 women; age, 42–79 years). Induction chemotherapy resulted in partial or complete remission (20 patients) and in stable (2 patients) or progressive (1 patient) disease. In partial or complete remission, subsequent radiotherapy was performed in 16 patients, chemoradiotherapy in two, and transoral resection in two. In stable or progressive disease, subsequent open surgery was performed. Overall, one patient died of cervical lymph node metastasis, one died of kidney cancer, and one died of myocardial infarction. Event‐free, distant‐metastasis–free survival was present for 20 patients. The 3‐year disease‐specific survival was 95%; the overall survival was 87%. Two patients required gastrostomies during chemoradiotherapy and three required tracheotomies, but these were closed in all patients. Conclusion The therapeutic response to induction chemotherapy for p16‐positive oropharyngeal cancer was good. Partial or complete remission was achieved in almost 90% patients, and control of local and distant metastases was possible when it was followed by radiotherapy alone or with transoral resection of the primary tumor. A multicenter study is required to confirm these findings. Level of Evidence 4.
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Mizuo Ando
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Go Omura
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Kazuo Yasuhara
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Masafumi Yoshida
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | | | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
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Lim GC, Holsinger FC, Li RJ. Transoral Endoscopic Head and Neck Surgery: The Contemporary Treatment of Head and Neck Cancer. Hematol Oncol Clin North Am 2015; 29:1075-92. [PMID: 26568549 DOI: 10.1016/j.hoc.2015.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traditional open surgical approaches are indicated for treatment of select tumor subsites of head and neck cancer, but can also result in major cosmetic and functional morbidity. Transoral surgical approaches have been used for head and neck cancer since the 1960s, with their application continuing to evolve with the changing landscape of this disease and recent innovations in surgical instrumentation. The potential to further reduce treatment morbidity with transoral surgery, while optimizing oncologic outcomes, continues to be investigated. This review examines current literature evaluating oncologic and quality-of-life outcomes achieved through transoral head and neck surgery.
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Affiliation(s)
- Gil Chai Lim
- Department of Otolaryngology-Head and Neck Surgery, Jeju National University School of Medicine, 102 Jejudaehak-ro, Jeju Special Self-Governing Province 63243, Republic of Korea
| | - Floyd Christopher Holsinger
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA
| | - Ryan J Li
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Palo Alto, CA 94305-5820, USA.
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