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Laccourreye O, Garcia D, Rahman A, Holsinger FC. Ten-Year Efficacy of Transoral Surgery for Squamous Carcinoma of the Lateral Oropharynx. Laryngoscope 2024. [PMID: 38932658 DOI: 10.1002/lary.31574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To document the 10-year results of transoral mandibular preservation surgery for patients with T1-2 squamous cell carcinoma (SCC) arising from the lateral oropharynx. METHODS This was a retrospective 30-year review using STROBE guidelines at an academic, tertiary referral center. A total of 294 patients with T1-2 SCC of the lateral oropharynx were reviewed. Only 19% of patients were never-smokers, suggesting a predominantly HPV-negative population. All patients had transoral mandibular preservation surgery. Follow-up therapy included neck dissection (76.5%), induction chemotherapy (57.8%), and postoperative radiation therapy (31.6%) Local control, survival, and functional endpoints, as well as the consequences of local recurrence, were analyzed. RESULTS The 10-year local disease control was 88.3%. Local recurrence was salvaged in 50% of cases, resulting in an overall 94.5% local control rate. The overall 10-year survival was 50%. Mortality was related to metachronous second primary cancer (MSPC) (29.2%), medical comorbidities (25.7%), uncontrolled local recurrence (10%), and complications following transoral resection (4.2%). In multivariate analysis, the development of an MSPC significantly increased (p < 0.005) the risk of death. Overall, 95.2% of patients achieved mandibular preservation. However, gastrostomy and tracheostomy dependence occurred in 1% and 0.3% of cases, respectively. CONCLUSIONS For a patient population with a significant percentage of tobacco-associated oropharyngeal cancer (OPC), transoral surgery was associated with long-term minimal postoperative complications and a high rate of local control. MSPC was the main cause of death during the first 10 postoperative years. Such long-term figures support transoral surgery as an effective first-line treatment for early-stage predominantly tobacco-related OPC. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Ollivier Laccourreye
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Paris, France
| | - Dominique Garcia
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, AP-HP, Paris, France
| | - Arifeen Rahman
- Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A
| | - F C Holsinger
- Division of Head & Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California, U.S.A
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Albi C, Ciorba A, Bianchini C, Cammaroto G, Pelucchi S, Sgarzani R, Gessaroli M, DE Vito A, Vicini C, Meccariello G. Transoral robotic surgery for oropharyngeal cancer: a systematic review on the role of margin status. Minerva Surg 2024; 79:346-353. [PMID: 38618712 DOI: 10.23736/s2724-5691.24.10235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Nowadays, robotic surgery finds application in the field of head and neck in the treatment of oropharyngeal tumors. The aim of this work is to examine the efficacy of transoral robotic surgery (TORS) in performing safe oncological resections of oropharyngeal squamous cell carcinoma (OPSCC), with particular attention to the status of margins. EVIDENCE ACQUISITION Literature search of English-language studies focused on TORS through PubMed, the Cochrane Library and EMBASE databases. A total of 431 papers returned to search, but only 24 met the inclusion criteria. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. EVIDENCE SYNTHESIS Within the selected studies, the overall rate of OPSCC positive margins following TORS is minimal, especially when patient selection is adequate and when TORS is used by high volume centers. CONCLUSIONS TORS is a very precise and viable therapeutic tool that provides good results in terms of surgical radicality with low positive margin rates and good results in terms of overall survival and disease-free survival; however, there is still a great heterogeneity in margins definition within the available literature. Consequently, even if this surgical approach is very promising, it is still challenging to draw firm conclusions nowadays.
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Affiliation(s)
- Cecilia Albi
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy -
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Giovanni Cammaroto
- ENT Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Forlì-Cesena, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
| | - Rossella Sgarzani
- Unit of Plastic Surgery, Center of Major Burns, Maurizio Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Manlio Gessaroli
- Unit of Maxillo-Facial Surgery, Maurizio Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Andrea DE Vito
- ENT Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Forlì-Cesena, Italy
| | - Claudio Vicini
- ENT and Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Ferrara, Italy
- ENT Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Forlì-Cesena, Italy
| | - Giuseppe Meccariello
- ENT Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Forlì-Cesena, Italy
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30-day morbidity and mortality after transoral robotic surgery for human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma: A retrospective analysis of two prospective adjuvant de-escalation trials (MC1273 & MC1675). Oral Oncol 2023; 137:106248. [PMID: 36603364 DOI: 10.1016/j.oraloncology.2022.106248] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dose de-escalation of adjuvant therapy (DART) in patients with HPV(+)OPSCC was investigated in two prospective Phase II and III clinical trials (MC1273 and MC1675). We report the 30-day morbidity and mortality associated with primary TORS resection in patients enrolled in these trials. MATERIALS AND METHODS Patients with HPV(+)OPSCC, who underwent TORS resection between 2013 and 2020 were considered in this analysis. The severity of postoperative transoral bleeding was graded using both the Hinni Grade (HG) transoral surgery bleeding scale and the Common Terminology for Adverse Events (CTCAE) v5.0. Post-surgical complications within 30 days of surgery, as well as rates of tracheostomy, PEG and nasogastric tube placement. RESULTS 219 patients were included. A total of 7 (3.2 %) patients had a tracheostomy placed at the time of surgery, and all were decannulated within 26 days (median: 5, range: 2-26). There were 33 (15.1 %) returns to the emergency department (ED) with 10 (4.6 %) patients requiring readmission. Using the HG scale, 10 (4.6 %) patients experienced ≥ Grade 3 bleeding with no Grade 5 or 6 bleeds. In contrast, using the CTCAE scale, 15 patients (6.8 %) experienced ≥ Grade 3 bleeding with no Grade 5 bleeds. There was one post-operative death in a patient withdrawn from the trial, and no deaths related to hemorrhage. CONCLUSION AND RELEVANCE TORS for HPV(+)OPSCC in carefully selected patients at a high volume center was associated with low morbidity and mortality.
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Li H, Zhang X, Chen W, Zhang Q, Li Q, Chen S, Yang Z, Su X, Yan S, Yang A, Song M. Analysis of T1-T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery. Laryngoscope Investig Otolaryngol 2023; 8:103-112. [PMID: 36846425 PMCID: PMC9948596 DOI: 10.1002/lio2.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
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. Level of Evidence 4.
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Affiliation(s)
- Hui Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xing Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wenkuan Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Quan Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiuli Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shuwei Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhongyuan Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xuan Su
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shida Yan
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ankui Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ming Song
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
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Panda NK, Kapoor A, Goel N, Ghoshal S, Singh V, Bal A. Analysis of Outcomes following TORS in a Mixed Cohort of Recurrent and New T1-T2 Oropharyngeal Cancer- A Single Institution Study. Indian J Otolaryngol Head Neck Surg 2022; 74:555-563. [PMID: 36514439 PMCID: PMC9741672 DOI: 10.1007/s12070-022-03139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose . The transoral robotic surgery is a newer modality being used in surgical treatment of early oropharyngeal cancer. The aim of this study is to assess the outcome of these cases in terms of two year disease free survival and overall survival. Methods Between July 2016 and September 2018, 58 patients suffering from early oropharyngeal cancer underwent transoral robotic surgery with neck dissection at a tertiary referral centre. 43 of them have completed two years follow up and were analyzed for disease free survival and overall survival. 41 patients had HPV analysis done . Results The surgical margins were positive in 9/43 patients ( 6 in upfront surgery and 3 in the salvage cohort). Adjuvant therapy was administered to 16/34 patients on account of either positive margins or multiple nodal metastasis. 88% patients were found to be HPV negative. The two year disease free survival for the upfront cohort was 88.2% and salvage cohort was 55.5%. The overall survival was 86.05%. Conclusions The study highlights good locoregional control and two year disease free survival in HPV negative oropharyngeal cancer undergoing robotic surgery. Additionally, a positive surgical margin and recurrence were the statistically significant variables influencing 2 year disease free survival. Trans oral robotic surgery is an excellent tool for early tumors of the oropharynx. The presence of a positive surgical margin is a grim sign for survival and has a significant impact on positive outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03139-5.
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Affiliation(s)
- Naresh K Panda
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
| | - Archit Kapoor
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
| | - Nitika Goel
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
| | - Sushmita Ghoshal
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
| | - Varinder Singh
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
| | - Amanjit Bal
- Professor and Head Department of Otolaryngology Head Neck Surgery PGIMER, 160012 Chandigarh, India
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Wu X, Pastel DA, Khan R, Eskey CJ, Shi Y, Sramek M, Paydarfar JA, Halter RJ. Quantifying Tumor and Vasculature Deformations during Laryngoscopy. Ann Biomed Eng 2022; 50:94-107. [PMID: 34993696 PMCID: PMC9035291 DOI: 10.1007/s10439-021-02896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 01/09/2023]
Abstract
Retractors and scopes used in head and neck surgery to provide adequate surgical exposure also deform critical structures in the region. Surgeons typically use preoperative imaging to plan and guide their tumor resections, however the large tissue deformation resulting from placement of retractors and scopes reduces the utility of preoperative imaging as a reliable roadmap. We quantify the extent of tumor and vasculature deformation in patients with tumors of the larynx and pharynx undergoing diagnostic laryngoscopy. A mean tumor displacement of 1.02 cm was observed between the patients' pre- and intra-operative states. Mean vasculature displacement at key bifurcation points was 0.99 cm. Registration to the hyoid bone can reduce tumor displacement to 0.67 cm and improve carotid stem angle deviations but increase overall vasculature displacement. The large deformation results suggest limitations in reliance on preoperative imaging and that using specific landmarks intraoperatively or having more intraoperative information could help to compensate for these deviations and ultimately improve surgical success.
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Affiliation(s)
- Xiaotian Wu
- Gordon Center for Medical Imaging at Massachusetts General Hospital and Harvard Medical School, 13th St, CNY149-5212, Charlestown, MA, 02129, USA.
| | - David A Pastel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
| | - Rihan Khan
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
| | - Clifford J Eskey
- Department of Radiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
| | - Yuan Shi
- Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
| | - Michael Sramek
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
| | - Joseph A Paydarfar
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
- Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH, 03756, USA
| | - Ryan J Halter
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd., Hanover, NH, 03755, USA
- Thayer School of Engineering at Dartmouth College, 14 Engineering Dr., Hanover, NH, 03755, USA
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Daigle O, Gardner JR, King D, Moreno MA, Sunde J, Vural E. Preemptive Utilization of Anterior Belly of the Digastric Muscle Flaps in Transoral Robotic Radical Tonsillectomy. OTO Open 2021; 5:2473974X211035102. [PMID: 34396028 PMCID: PMC8358520 DOI: 10.1177/2473974x211035102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To demonstrate the use of an anterior belly of the digastric muscle flap (ABDMF) during transoral robotic radical tonsillectomy (TORRT) with concomitant neck dissection with the intent of preventing the formation of postoperative pharyngocutaneous fistulas. Study Design Retrospective study. Setting Single academic tertiary care center. Methods In this study, all patients were included who underwent TORRT plus limited pharyngectomy with concomitant neck dissection and ABDMF for the treatment of oropharyngeal squamous cell carcinoma between September 2012 and September 2020. The rate of fistula formation was assessed in patients with preemptive utilization of ABDMF. Results A total of 43 patients underwent TORRT with neck dissection and ABDMF. No patients developed a fistula in the postoperative period or associated morbidity with the use of this flap. Conclusion Preemptive use of ABDMF in TORRT with concomitant neck dissection represents a reconstructive option that may help prevent the formation of pharyngocutaneous fistula by reinforcing the posteroinferior boundary of the parapharyngeal space.
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Affiliation(s)
- Olivia Daigle
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James Reed Gardner
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne King
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mauricio Alejandro Moreno
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jumin Sunde
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Emre Vural
- Division of Head and Neck Oncology Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Post-operative outcomes of different surgical approaches to oropharyngeal squamous cell cancer: a case-matched study. The Journal of Laryngology & Otology 2021; 135:348-354. [PMID: 33818328 DOI: 10.1017/s0022215121000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the post-operative outcomes of transoral laser microsurgery, lateral pharyngotomy and transmandibular surgery in oropharyngeal cancer management. METHODS Records of 162 patients treated with transmandibular surgery, transoral laser microsurgery or lateral pharyngotomy were reviewed. The transoral laser microsurgery cohort was matched with the lateral pharyngotomy and transmandibular surgery cohorts for tumour stage, tumour subsite and human papilloma virus status, and the intra- and post-operative outcomes were compared. RESULTS Duration of surgery and hospital stay were significantly longer for transmandibular surgery. Tracheostomy and nasogastric feeding tube rates were similar, but time to decannulation and to oral feeding were longer in the transmandibular surgery group. Transmandibular surgery more frequently required flap reconstruction and had a greater complication rate. Negative margins were fewer in the lateral pharyngotomy group than in the transoral laser microsurgery and transmandibular surgery groups. CONCLUSION In comparison with transmandibular surgery, transoral laser microsurgery and lateral pharyngotomy were associated with fewer complications and faster functional recovery. Lateral pharyngotomy had a higher rate of positive margins than transoral laser microsurgery, with a consequently greater need for adjuvant therapy. Many patients are nonetheless unsuitable for transoral surgery. All these factors should be considered when deciding on oropharyngeal cancer surgical treatment.
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Does HPV Subtype Predict Outcomes in Head and Neck Cancers? Int J Otolaryngol 2021; 2021:6672373. [PMID: 33824664 PMCID: PMC8006754 DOI: 10.1155/2021/6672373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/06/2020] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Recently, reanalysis of The Cancer Genome Atlas study demonstrated that human papillomavirus (HPV) genotypes in head and neck cancers other than HPV-16 have inferior survival to HPV-16-positive tumors. We aimed to examine the association of HPV subtypes and survival in a large cohort of patient samples from our institution. Methods Fresh frozen primary site biopsy samples were collected either in clinic or at the time of surgery. Patient demographic, staging, and survival data were also collected. Tumors were tested for HPV subtypes by quantitative polymerase chain reaction (qPCR). Univariable and multivariable analyses were performed using Cox proportional hazards regression. Results 280 patient biopsy samples were collected between 2011 and 2017. Mean ± standard deviation (SD) age was 61.9 ± 11.1 years and most patients (78%) were male. The majority of cancers were of the oral cavity (60%) or oropharynx (25%) and 30% had HPV-positive disease. Median follow-up was 3.76 years and 96/280 patients (34%) developed recurrences. Patients with p16-positive versus negative disease had significantly improved 5-year overall survival (OS, 77.6% vs. 53.3%; p=0.009) and progression-free survival (PFS, 67.3% vs. 41.0%, p=0.006). Similarly improved 5-year OS and PFS were observed for patients with HPV-positive versus negative disease (65.0% vs. 55.0%, p=0.084; 53.3% vs. 43.2%, p=0.072, resp.). Patients with HPV-16 compared to other HPV diseases had worse 5-year OS and PFS (62.1% vs. 88.9%, p=0.273; 49.0% vs. 88.9%, p=0.081, resp.). Conclusions In contrast to the data derived from The Cancer Genome Atlas, patients with HPV-16 tumors trended towards decreased PFS and OS compared with tumors driven by other HPV genotypes. Further larger multi-institutional studies are necessary to understand the relationship between other HPV genotypes and survival in head and neck squamous cell carcinomas.
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HPV/p16-positive oropharyngeal cancer treated with transoral robotic surgery: The roles of margins, extra-nodal extension and adjuvant treatment. Am J Otolaryngol 2021; 42:102793. [PMID: 33130532 DOI: 10.1016/j.amjoto.2020.102793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treatment outcomes are re-defining management. Traditional margins, the role of extranodal extension (ENE) and adjuvant treatment intensity continue to be debated. This study aimed to determine the impact of margins, ENE and adjuvant therapy on survival following transoral robotic surgery (TORS). METHODS Patients treated with TORS at an academic center were retrospectively identified (2013-2019). Survival outcomes were evaluated using Kaplan-Meier curves. RESULTS 48 patients were included. 40 (83%) were male. Mean age was 61.2 years. 43 (90%) were stage I. 22 (45.8%) had ENE. 31 (65%) had margins >1 mm. 38 (79%) had indications for radiation therapy; 9 (24%) refused. Chemotherapy was recommended in 36 (75%) patients; 24 (67%) refused. Locoregional control was 98%, metastasis-free survival was 96%, and disease-specific survival was 100% at 5-years. Overall survival was 95%. CONCLUSIONS Given the high survival rate seen after TORS, it is likely that margins, ENE and adjuvant treatment may not significantly contribute to outcomes.
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Swisher-McClure S, Lukens JN, Aggarwal C, Ahn P, Basu D, Bauml JM, Brody R, Chalian A, Cohen RB, Fotouhi-Ghiam A, Geiger G, Gershowitz J, Livolsi V, Mitra N, Montone K, Newman J, Ojerholm E, O'Malley B, Rajasekaran K, Tan E, Weinstein G, Lin A. A Phase 2 Trial of Alternative Volumes of Oropharyngeal Irradiation for De-intensification (AVOID): Omission of the Resected Primary Tumor Bed After Transoral Robotic Surgery for Human Papilloma Virus-Related Squamous Cell Carcinoma of the Oropharynx. Int J Radiat Oncol Biol Phys 2019; 106:725-732. [PMID: 31785337 DOI: 10.1016/j.ijrobp.2019.11.021] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE This trial tested the safety and efficacy of a novel, deintensified radiation therapy (RT) approach after initial surgical resection for patients with human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS AND MATERIALS This single-arm phase 2 prospective clinical trial enrolled 60 patients with stage pT1-pT2 N1-3 HPV-associated OPSCC treated with transoral robotic surgery (TORS) and selective neck dissection at a single institution between May 2014 and September 2017. Patients had favorable features at the primary site (negative surgical margins ≥2 mm, no perineural invasion, and no lymphovascular invasion) but required adjuvant therapy based on lymph node involvement. Surgeries were all performed at a high-volume head and neck cancer center with expertise in TORS. Patients received postoperative RT to at-risk areas in the involved neck (60-66 Gy) and uninvolved neck (54 Gy). The resected primary site was treated as an active avoidance structure in the treatment planning of postoperative RT. Concurrent chemotherapy was administered for patients with extranodal extension. RESULTS Median follow-up of the 60 patients enrolled was 2.4 years (range, 8.5-53.8 months). A single patient recurred at the primary site, for 2-year local control of 98.3%. One patient (1.7%) developed a regional neck recurrence, and 2 patients (3.3%) developed distant metastases. Measured 2-year local recurrence-free survival was 97.9% (95% confidence interval, 86.1%-99.7%). Overall survival was 100% at the time of analysis. The mean radiation dose to the primary site was 36.9 Gy (standard deviation, 10.3 Gy). Two patients (3.3%) experienced late soft tissue necrosis in the primary site surgical bed that resolved within 2 months. Feeding tube dependence rates were 0% during RT, 3.3% temporarily during follow-up, and 0% at last follow-up. CONCLUSIONS Deintensified postoperative RT that avoids the resected primary tumor site and targets only the at-risk neck after TORS for selected patients with HPV-associated OPSCC may be safe and is worthy of further study.
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Affiliation(s)
- Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charu Aggarwal
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devraj Basu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Brody
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ara Chalian
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alireza Fotouhi-Ghiam
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Geiger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jared Gershowitz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia Livolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Newman
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bert O'Malley
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik Tan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Weinstein
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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12
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Gorphe P, Simon C. A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma. Oral Oncol 2019; 98:69-77. [DOI: 10.1016/j.oraloncology.2019.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/03/2023]
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13
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Shenouda K, Rubin F, Garcia D, Badoual C, Bonfils P, Laccourreye O. Evaluation of robotic surgery for transoral resection of T1-2 squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:31-36. [PMID: 31561975 DOI: 10.1016/j.anorl.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
GOAL To evaluate transoral robotic surgery (TORS) for isolated previously untreated squamous cell carcinoma (SCC) of the tonsillar fossa classified as T1-2. METHOD Retrospective analysis of two cohorts of isolated untreated T1-2 tonsillar fossa SCC consecutively operated on by a transoral approach, with (R=21) and without (NR=24) robotic assistance, in the period 2006-2014. Three main (survival, local control, and operative morbidity) and three secondary (pathologic data, incidence and duration of tracheotomy and nasogastric intubation, and hospital stay) endpoints were compared between groups. The significance threshold was set at P< .005. RESULTS Three- and five-year actuarial survival estimates were 80.2% and 74.5% respectively in group R, and 91.5% and 82.5% respectively in group NR (NS: P=.34). Three- and five-year actuarial local control estimates were 90% and 90% respectively in group R, and 95.8% and 91% respectively in group NR (NS: P=.81). There were no significant differences in morbidity, tracheotomy/nasogastric intubation time, or hospital stay. Positive resection margins (R1) were noted in 38.1% and 16.7% in groups R and NR, respectively (NS: P=.05) without significant impact on 5-year actuarial local control (P=0.78). CONCLUSION Robotic assistance in transoral lateral oropharyngectomy for T1-2 tonsillar fossa SCC did not significantly impact oncologic or functional outcome.
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Affiliation(s)
- K Shenouda
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - F Rubin
- Clinique St-Vincent, 97404 Saint-Denis cedex, Reunion
| | - D Garcia
- Clinique d'Arcachon, 33164, La Teste de Buch, France
| | - C Badoual
- Service d'anatomopathologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 75015 Paris, France
| | - P Bonfils
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'otorhinolaryngologie, HEGP, université Paris-Descartes Sorbonne Paris-Cité, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
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14
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Ibrahim AS, Civantos FJ, Leibowitz JM, Thomas GR, Arnold DJ, Franzmann EJ, Nicolli EA, Lo K, Nemeth Z, Sargi ZB, Weed DT. Meta‐analysis comparing outcomes of different transoral surgical modalities in management of oropharyngeal carcinoma. Head Neck 2019; 41:1656-1666. [DOI: 10.1002/hed.25647] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmed S. Ibrahim
- Department of Surgical OncologyNational Cancer Institute – Cairo University Egypt
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Francisco J. Civantos
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Jason M. Leibowitz
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Giovana R. Thomas
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - David J. Arnold
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Elizabeth J. Franzmann
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Elizabeth A. Nicolli
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Kaming Lo
- Department of Public Health Sciences ‐ Division of BiostatisticsUniversity of Miami Miller School of Medicine Miami Florida
| | - Zsuzsanna Nemeth
- Louis Calder Memorial LibraryUniversity of Miami Miller School of Medicine Miami Florida
| | - Zoukaa B. Sargi
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Donald T. Weed
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
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15
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Clark JM, Holmes EM, O'Connell DA, Harris J, Seikaly H, Biron VL. Long-term survival and swallowing outcomes in advanced stage oropharyngeal squamous cell carcinomas. PAPILLOMAVIRUS RESEARCH 2018; 7:1-10. [PMID: 30267774 PMCID: PMC6258135 DOI: 10.1016/j.pvr.2018.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a paucity of studies reporting long-term survival outcomes for HPV/p16 positive oropharyngeal squamous cell carcinoma (OPSCC). This study aims to compare long-term outcomes of advanced stage p16 positive and negative OPSCCs, treated by surgical and non-surgical modalities. METHODS OPSCC patients from 1998 to 2012 were identified through a prospectively collected cancer registry. P16 immunohistochemistry was used as a surrogate marker for HPV-OPSCC. Overall survival (OS) and aspiration free survival (AFS) comparisons were made between patients treated with chemoradiation (CRT) versus primary surgery and radiation/chemoradiation (S+RT/CRT) at 5, 10 and 15 years post-treatment. RESULTS A total of 319 patients were included. P16 positive patients and non-smokers had significantly higher long-term (5, 10 and 15-year) OS. Smokers and p16 negative patients treated with S+RT/CRT had improved long-term OS compared to patients who received CRT. Smokers and p16 negative patients had lower long-term AFS. Multivariate analysis showed improved OS was associated with p16 positivity (HR 0.42, 0.28-0.61) and surgery (HR 0.47, 0.32-0.69), whereas lower OS was associated with ECOG ≥ 2 (HR 2.46, 1.61-3.77), smoking (HR 2.37, 1.41-3.99) and higher stage (HR 1.68, 1.05-2.68). CONCLUSIONS In smokers and p16-negative OPSCC patients, primary surgery may be associated with improved long-term survival and dysphagia-related outcomes.
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Affiliation(s)
- Jessica M Clark
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7.
| | - Emma M Holmes
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
| | - Daniel A O'Connell
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7; Alberta Head & Neck Centre for Oncology and Reconstruction, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7
| | - Jeffrey Harris
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7; Alberta Head & Neck Centre for Oncology and Reconstruction, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7.
| | - Hadi Seikaly
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7; Alberta Head & Neck Centre for Oncology and Reconstruction, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7.
| | - Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7; Alberta Head & Neck Centre for Oncology and Reconstruction, 8440-112 st, Edmonton, Alberta, Canada T6G 2B7.
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16
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Sim FW, Xiao HD, Bell RB. Margin Analysis: Squamous Cell Carcinoma of the Oropharynx. Oral Maxillofac Surg Clin North Am 2018; 29:269-280. [PMID: 28709530 DOI: 10.1016/j.coms.2017.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the common shared risk factors of smoking and heavy alcohol consumption, literature involving oropharyngeal squamous cell carcinoma (OPSCC) is often combined with oral squamous cell carcinoma. Human papilloma virus is now confirmed to be a major risk factor of OPSCC with its distinct epidemiology and favorable treatment outcome. The impact of adjuvant chemoradiation in the setting of positive surgical margins remains unclear but is likely influenced by tumor biology. This article reviews the tumor biology of OPSCC and summarizes recent findings on outcomes following surgical treatment of OPSCC.
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Affiliation(s)
- Felix W Sim
- Head and Neck Institute, Providence Cancer Center, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA
| | - Hong D Xiao
- Head and Neck Pathologist, Department of Pathology, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA
| | - R Bryan Bell
- Head and Neck Institute, Providence Cancer Center, Providence Portland Medical Center, 4805 Northeast Glisan Street, Suite 6N50, Portland, OR 97213, USA.
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17
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The Latest Advancements in Selective Neck Dissection for Early Stage Oral Squamous Cell Carcinoma. Curr Treat Options Oncol 2017; 18:31. [PMID: 28474264 DOI: 10.1007/s11864-017-0471-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT The management of cervical lymph node metastasis remains a crucial component of the treatment of head and neck cancers. However, the proper management of clinical N 0 cases with early-stage oral squamous cell carcinoma (OSCC) remains undefined. In the advent of minimally invasive techniques in the 1980s, these techniques have gained popularity among numerous surgeons in all fields of surgery. Although there are no randomized controlled trial data comparing the outcomes of minimally invasive techniques (endoscopically assisted selective neck dissection (SND), robot-assisted SND) with conventional techniques, encouraging evidence from several studies suggests that both endoscopically assisted SND and robot-assisted SND are safe, minimally invasive techniques with achieved short-term oncologic outcomes and can reach a better cosmetic outcome than conventional SND. In this review, we also compare the indications, surgical approaches, and relative advantages and disadvantages of conventional SND, endoscopically assisted SND, and robot-assisted SND to provide surgeons with a means to better consider these techniques for the treatment of early-stage OSCC.
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18
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The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:259-264. [DOI: 10.1016/j.anorl.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Arnaoutakis D, Sumer BD. Treatment Deintensification for Human Papillomavirus-Associated Oropharyngeal Cancer. Ann Surg Oncol 2017; 24:3463-3465. [PMID: 28799138 DOI: 10.1245/s10434-017-6045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Demetri Arnaoutakis
- Division of Head & Neck Cancer, Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA
| | - Baran D Sumer
- Division of Head & Neck Cancer, Department of Otolaryngology, Head & Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA.
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20
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Park YM, Jung CM, Cha D, Kim DH, Kim HR, Keum KC, Cho NH, Kim SH. A New Clinical Trial of Neoadjuvant Chemotherapy Combined With Transoral Robotic Surgery and Customized Adjuvant Therapy for Patients With T3 or T4 Oropharyngeal Cancer. Ann Surg Oncol 2017; 24:3424-3429. [DOI: 10.1245/s10434-017-6001-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Indexed: 01/21/2023]
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21
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Gamez ME, Halyard MY, Hinni ML, Hayden RE, Nagel TH, Vargas CE, Wong WW, Curtis KK, Zarka MA, Ma D, Patel SH. Mucosal Sparing Radiation Therapy in Resected Oropharyngeal Cancer. Ann Otol Rhinol Laryngol 2017; 126:185-191. [PMID: 28056518 DOI: 10.1177/0003489416681580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the outcomes of patients with favorable risk oropharyngeal cancer that underwent adjuvant radiation therapy with omission of the primary site from the clinical target volume (CTV). MATERIAL/METHODS A retrospective study of 40 patients treated with transoral surgery (TOS) followed by neck only radiation using intensity modulated radiation therapy (IMRT) with exclusion of the primary site. For all patients, a CTV of the primary surgical bed was contoured to obtain the estimated incidental dose to the primary site. RESULTS Median follow-up was 51 months (range, 13-155 months). The median radiation therapy (RT) dose to the neck was 6000 cGy (range, 5400-6400 cGy). The mean incidental dose to the primary tonsillar site was 4320 cGy (SD ± 480 cGy) and to the primary base of tongue site was 4060 cGy (SD ± 420 cGy). There were no local failures and only 1 regional failure, resulting in 97.5% locoregional control rate at 4 years. Two patients developed distant metastases, without evidence of locoregional recurrence, for a 4-year overall survival rate of 97%. CONCLUSIONS Our analysis suggests that mucosal sparing RT after TOS in favorable risk oropharyngeal cancer patients may provide comparable oncologic and improved functional outcomes compared to conventional treatment in selected patients.
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Affiliation(s)
- Mauricio E Gamez
- 1 Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Michael L Hinni
- 2 Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona
| | | | - Thomas H Nagel
- 2 Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona
| | - Carlos E Vargas
- 1 Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - William W Wong
- 1 Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Kelly K Curtis
- 3 Division of Hematology/Medical Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Matthew A Zarka
- 4 Department of Medicine-Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Daniel Ma
- 5 Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- 1 Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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22
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Fundakowski CE, Lango M. Considerations in surgical versus non-surgical management of HPV positive oropharyngeal cancer. CANCERS OF THE HEAD & NECK 2016; 1:6. [PMID: 31093336 PMCID: PMC6457136 DOI: 10.1186/s41199-016-0007-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/21/2016] [Indexed: 01/14/2023]
Abstract
Given the marked difference in clinical presentation and treatment response based on human papilloma virus (HPV) status, HPV-associated oropharyngeal squamous cell carcinoma is now viewed as a distinct biologic and clinical entity. HPV-associated oropharyngeal squamous cell carcinoma has increased by nearly 7.5 % per year, from approximately 16 % in the early 1980′s to nearly 70 % today, and is believed will continue to increase dramatically in the coming years. Currently, a myriad of treatment options exist for these patients as many active clinical trials are underway which aim to identify the most appropriate interventions for this unique group of patients. This review aims to provide considerations between surgical and non-surgical management for HPV-associated oropharyngeal squamous cell carcinoma.
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Affiliation(s)
| | - Miriam Lango
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111 USA
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23
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Beitler JJ, Quon H, Jones CU, Salama JK, Busse PM, Cooper JS, Koyfman SA, Ridge JA, Saba NF, Siddiqui F, Smith RV, Worden F, Yao M, Yom SS. ACR Appropriateness Criteria®Locoregional therapy for resectable oropharyngeal squamous cell carcinomas. Head Neck 2016; 38:1299-309. [DOI: 10.1002/hed.24447] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Harry Quon
- Johns Hopkins University; Baltimore Maryland
| | | | | | - Paul M. Busse
- Massachusetts General Hospital; Boston Massachusetts
| | | | | | - John A. Ridge
- Fox Chase Cancer Center; Philadelphia Pennsylvania, American College of Surgeons
| | - Nabil F. Saba
- Emory University; Atlanta Georgia, American Society of Clinical Oncology
| | | | - Richard V. Smith
- Montefiore Medical Center; Bronx New York, American College of Surgeons
| | - Francis Worden
- University of Michigan; Ann Arbor Michigan, American Society of Clinical Oncology
| | - Min Yao
- University Hospital Case Medical Center; Cleveland Ohio
| | - Sue S. Yom
- University of California San Francisco; San Francisco California
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24
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Sadeghi N, Li NW, Taheri MR, Easley S, Siegel RS. Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach. Head Neck 2016; 38:1837-1846. [DOI: 10.1002/hed.24526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nader Sadeghi
- Division of Otolaryngology - Head and Neck Surgery; George Washington University; Washington DC
| | - Ning-Wei Li
- Division of Otolaryngology - Head and Neck Surgery; George Washington University; Washington DC
| | - M. Reza Taheri
- Department of Radiology; George Washington University; Washington DC
| | - Samantha Easley
- Department of Pathology; George Washington University; Washington DC
| | - Robert S. Siegel
- Division of Medical Oncology; George Washington University; Washington DC
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25
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Kumar B, Cipolla MJ, Old MO, Brown NV, Kang SY, Dziegielewski PT, Durmus K, Ozer E, Agrawal A, Carrau RL, Schuller DE, Leon ME, Pan Q, Kumar P, Wood V, Burgers J, Wakely PE, Teknos TN. Surgical management of oropharyngeal squamous cell carcinoma: Survival and functional outcomes. Head Neck 2015; 38 Suppl 1:E1794-802. [PMID: 26694981 DOI: 10.1002/hed.24319] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to further define the impact of primary surgery in the management of oropharyngeal squamous cell carcinoma (SCC). METHODS Two hundred ninety-six patients with oropharyngeal SCC treated with primary surgery were included. Multivariable analysis and recursive partitioning analysis (RPA) identified predictors of survival and gastrostomy tube presence. RESULTS Multivariable analysis identified that HPV negativity (p = .0002), presence of extranodal extension (p = .0025), and advanced T classification (p = .0081) were independent predictors of survival. For HPV-positive patients, surgical approach (p = .0111) and margin status (p = .0287) were significant predictors of survival. For HPV-negative patients, extranodal extension (p = .0021) and advanced T classification (p = .0342) were significant predictors of survival. Smoking status and advanced neck disease did not impact survival, and the addition of adjuvant chemotherapy did not confer survival benefit in HPV-positive or HPV-negative subgroups. CONCLUSION Independent predictors of survival are unique in patients with oropharyngeal SCC treated with primary surgery. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1794-E1802, 2016.
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Affiliation(s)
- Bhavna Kumar
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael J Cipolla
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew O Old
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nicole V Brown
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter T Dziegielewski
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kasim Durmus
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Amit Agrawal
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David E Schuller
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marino E Leon
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Quintin Pan
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Pawan Kumar
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Valerie Wood
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jessica Burgers
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul E Wakely
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Theodoros N Teknos
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Dabas S, Dewan A, Ranjan R, Dewan AK, Shukla H, Sinha R. Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience. Asian Pac J Cancer Prev 2015; 16:7627-32. [DOI: 10.7314/apjcp.2015.16.17.7627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Smith RV, Schiff BA, Garg M, Haigentz M. The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients. Laryngoscope 2015; 125 Suppl 10:S1-S15. [DOI: 10.1002/lary.25534] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Richard V. Smith
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Bradley A. Schiff
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Madhur Garg
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Radiation Oncology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Missak Haigentz
- Department of Otorhinolaryngology-Head and Neck Surgery; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Medical Oncology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx New York U.S.A
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Mercante G, Masiello A, Sperduti I, Cristalli G, Pellini R, Spriano G. Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: A 1-year follow-up study. J Craniomaxillofac Surg 2015. [DOI: 10.1016/j.jcms.2015.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sakai M, Yokoyama J, Tashiro M, Ishikawa T. A novel procedure combining transoral resection and set-back tongue flap for oropharyngeal cancer. Acta Otolaryngol 2015; 135:736-40. [PMID: 25761449 DOI: 10.3109/00016489.2015.1011790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Seven patients with advanced lateral oropharyngeal cancer (T3N2bM0, or T4N2bM0) underwent transoral lateral oropharyngectomy (TLO) with reconstruction performed through set-back tongue flap and polyglycolic acid (PGA) sheet. TLO was performed following en bloc resection of tumors using endoscopy. To cover the resulting defect in the lateral oropharyngeal wall, the set-back tongue flap was moved posteriorly and laterally to the area of the tongue base and lateral pharyngeal wall. The tip of the set-back tongue flap was sutured to the lateral pharynx to reconstruct the elevated tongue base and altered anterior pillar. The defect on the floor of the mouth was reconstructed using a PGA sheet. Following surgery, the mean observation period was 24 months. The mean operating time was 4 h and 2 min, with an average blood loss of 68.1 ml. All oral intake resumed on the first postoperative day via gastric tube. The mean gastric tube removal time was 1.6 postoperative days as a result of sufficient oral intake. None of the patients received postoperative radiotherapy or displayed evidence of tumor recurrence. We conclude that this novel procedure is highly effective for treating advanced oropharyngeal cancer as it demonstrates good prognostic and functional outcomes.
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Affiliation(s)
- Mizuno Sakai
- Department of Otorhinolaryngology-Head and Neck Surgery, National Hospital Organization Tochigi Medical Center , Utsunomiya
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30
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Laccourreye O, Malinvaud D, Holostenco V, Ménard M, Garcia D, Bonfils P. Value and limits of non-robotic transoral oropharyngectomy for local control of T1-2 invasive squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:141-6. [DOI: 10.1016/j.anorl.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Patel AB, Hinni ML, Pollei TR, Hayden RE, Moore EJ. Severe prolonged dysphagia following transoral resection of bilateral synchronous tonsillar carcinoma. Eur Arch Otorhinolaryngol 2015; 272:3585-91. [DOI: 10.1007/s00405-015-3540-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
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32
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A novel distending laryngoscope: implications in transoral surgery. Eur Arch Otorhinolaryngol 2015; 273:1095-8. [DOI: 10.1007/s00405-015-3517-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
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Abstract
Treatment of squamous cell carcinoma of the oropharynx is challenging because of its effects on speech and swallowing, which may affect quality of life. Transoral robotic surgery may be an effective alternative to open surgery. Robotic lateral oropharyngectomy is best suited for early stage oropharyngeal squamous cell carcinoma, with the goal of avoiding or reducing the use or dose of adjuvant therapies. Successful robotic lateral oropharyngectomy requires appropriate training, detailed preoperative planning, organized operating room setup to obtain exposure, an understanding of the pertinent surgical anatomy, and knowledge of the postoperative care of the oncologic patient.
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Affiliation(s)
- Daniel Brickman
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Mail Code: PV01, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Neil D Gross
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Mail Code: PV01, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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Liu JC, Ridge JA, Brizel DM, O'Sullivan B, Cohen EW, Mann BS, Adelstein DJ. Current status of clinical trials in head and neck cancer 2014. Otolaryngol Head Neck Surg 2015; 152:410-7. [PMID: 25605695 DOI: 10.1177/0194599814566595] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The last few years have seen significant increase in the number of available clinical trials in head and neck cancer. It has been difficult to stay abreast of these efforts because multiple cooperative groups and institutions are engaged in their recruitment. This review presents the state of the art of available clinical trials organized around major research themes. DATA SOURCES Published literature, published cooperative group monographs, expert review. REVIEW METHODS Initial themes in head and neck cancer clinical trial development were first identified along with examples. Opinions from an international panel of multidisciplinary experts were then solicited. RESULTS/DISCUSSION Current major themes of head and neck clinical trials centered on 5 major themes: (1) recognition of human papillomavirus oropharynx cancer and optimal treatment strategies, (2) defining the role of transoral surgery in head and neck cancer treatment, (3) improving postoperative adjuvant treatment, (4) investigation of rare malignancies, and (5) the importance of biomarker-driven, innovative, and targeted therapy investigation. CONCLUSIONS A number of exciting clinical trials are currently in development or accrual with the potential for tremendous impact and improvement of the treatment of head and neck cancer. IMPLICATIONS FOR PRACTICE Awareness by practicing otolaryngologists and trainees of these current themes will be essential for study accrual, success, and improvement in the care of head and neck cancer.
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Affiliation(s)
- Jeffrey C Liu
- Head and Neck Surgery Section, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA Department of Otolaryngology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - John A Ridge
- Head and Neck Surgery Section, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - David M Brizel
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Canada
| | - Ezra W Cohen
- Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
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Transoral robotic surgery in management of oropharyngeal cancers: a preliminary experience at a tertiary cancer centre in India. Int J Clin Oncol 2014; 20:693-700. [DOI: 10.1007/s10147-014-0774-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022]
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Laccourreye O, Malinvaud D, Garcia D, Ménard M, Hans S, Cauchois R, Bonfils P. Postoperative Hemorrhage After Transoral Oropharyngectomy for Cancer of the Lateral Oropharynx. Ann Otol Rhinol Laryngol 2014; 124:361-7. [DOI: 10.1177/0003489414558109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Assessment of incidence, risk factors, management, and outcome of postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. Methods: Retrospective review of a cohort of 514 cancers of the lateral oropharynx consecutively resected. Results: Incidence of postoperative hemorrhage was 3.6%. In 31.5% of cases, onset was after hospital discharge. No hemorrhages occurred after the end of the fourth postoperative week. Variables associated with increased risk of hemorrhage were advanced age ( P = .004), antithrombotic treatment ( P = .012), and robotic assistance ( P = .009). When the source of hemorrhage could be identified, hemostasis, performed transorally in most cases, was highly effective; no patients in this subgroup showed recurrence. In spontaneously resolved hemorrhage under observation or when no active site of bleeding was found on exploration under general anesthesia, the recurrence rate was 18.1%. Overall, hemorrhage resulted in death in 2 patients. Conclusion: Exploration under general anesthesia in case of active bleeding and observation with discussion of arterial exploration of the ipsilateral external carotid system in patients in whom no source of bleeding can be identified are the keys to successful management of this potentially lethal complication.
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Affiliation(s)
| | - David Malinvaud
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | | | | | - Stéphane Hans
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Régis Cauchois
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Pierre Bonfils
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
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Mydlarz WK, Chan JYK, Richmon JD. The role of surgery for HPV-associated head and neck cancer. Oral Oncol 2014; 51:305-13. [PMID: 25456011 DOI: 10.1016/j.oraloncology.2014.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 09/01/2014] [Accepted: 10/06/2014] [Indexed: 01/27/2023]
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal cancer continues to increase in contrast to other head and neck cancer sites. There is a growing role for upfront surgery to treat these cancers in the era of organ preservation treatment strategies. This is becoming especially important in younger, healthier patients with HPV-associated squamous cell carcinoma. Surgery for oropharyngeal cancer has evolved from large, open transcervical and transmandibular approaches to minimally-invasive transoral endoscopic techniques. Advances in transoral endoscopic surgery (TES) have led to renewed interest in upfront surgical treatment for oropharyngeal carcinoma. Transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) are two techniques that allow for complete oncologic resection through the mouth in select patients, with minimal cosmetic deformity and optimal speech and swallow function after completion of therapy. In this article we will review transoral approaches to oropharyngeal carcinoma: its oncologic and functional outcomes, and its role in the multi-disciplinary treatment of oropharyngeal cancer.
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Affiliation(s)
- Wojciech K Mydlarz
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jason Y K Chan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Abstract
The striking rise in the incidence of HPV-related oropharyngeal squamous cell carcinomas and their improved prognosis compared to classical oropharyngeal cancer raises the question as to whether this subset of patients could benefit from less aggressive treatment without compromising efficacy. To achieve that goal, it is critically important to advance our understanding of the behavior of HPV-positive tumors. It is necessary to identify relevant clinical risk factors and to refine the current staging system. Several clinical trials studying various deintensification strategies are currently underway. This review presents some of the most valuable evidence in this regard in an attempt to encourage further exploration of risk stratification and risk-based therapy for patients with oropharyngeal cancer.
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Affiliation(s)
- Monica George
- Medway Maritime Hospital, NHS Foundation Trust, Gillingham, UK,
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39
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Oncological and functional outcomes of transoral surgery for the treatment of oropharyngeal cancer. Ir J Med Sci 2014; 184:825-30. [DOI: 10.1007/s11845-014-1183-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/09/2014] [Indexed: 11/25/2022]
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40
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Hammoudi K, Pinlong E, Kim S, Bakhos D, Morinière S. Transoral robotic surgery versus conventional surgery in treatment for squamous cell carcinoma of the upper aerodigestive tract. Head Neck 2014; 37:1304-9. [PMID: 24816480 DOI: 10.1002/hed.23752] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 03/21/2014] [Accepted: 05/07/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of our work was to compare a group of patients undergoing transoral robotic surgery (TORS group) for squamous cell carcinoma of the upper aerodigestive tract and a matched group of patients undergoing conventional surgery (conventional surgery group) for the same indication. METHODS In this retrospective single-center study, 26 patients were included in each group. RESULTS There were significantly fewer tracheotomies in the TORS group (p < .001). The mean durations of feeding by nasogastric tube and hospitalization were shorter for the TORS group (p = .001). There was no significant difference in disease-free survival at 3 years (p = .76). Mean treatment cost was $7124 lower for the TORS group (p = .03). CONCLUSION This comparative study shows that robotic technology can be used to treat selected squamous cell carcinomas of the upper aerodigestive tract, reducing morbidity and treatment costs while providing equivalent cancer control at 3 years.
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Affiliation(s)
- Karim Hammoudi
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
| | | | - Soo Kim
- CHRU Bretonneau, Tours Hospital, France
| | - David Bakhos
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
| | - Sylvain Morinière
- ENT Department, University François Rabelais.,CHRU Bretonneau, Tours Hospital, France
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Rahmati R, Dogan S, Pyke O, Palmer F, Awad M, Lee N, Kraus DH, Shah JP, Patel SG, Ganly I. Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation. Head Neck 2014; 37:800-7. [PMID: 24616252 DOI: 10.1002/hed.23679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/09/2014] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). METHODS Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. RESULTS Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was not predictive of outcome (DSS 80% for N0 vs 82% for N+; p = .97). Lymphovascular invasion was an independent predictor of OS, DSS, and RFS on multivariate analysis. CONCLUSION Lymphovascular invasion but not pathological stage of the neck is an independent predictor of outcome in patients with tonsillar SCC.
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Affiliation(s)
- Rahmatullah Rahmati
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Owen Pyke
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,State University of New York - Stony Brook, School of Medicine, Stony Brook, New York
| | - Frank Palmer
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mahmoud Awad
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Dennis H Kraus
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,Head and Neck Institute, North Shore Health System, Great Neck, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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43
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Abstract
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades mostly due to human papillomavirus (HPV)-related infections. Cancers resulting from HPV infection bear a better prognosis than those that are smoking-related. Because HPV-positive patients are often younger, with lower rates of co-morbid illness and longer overall life expectancies, long-term sequelae of therapy have become an important issue. Treatment of oropharyngeal cancers has typically involved the use of radiation and chemotherapy to avoid the morbidity of open surgery which included mandibulotomy and composite resection. Transoral robotic surgery (TORS) is an emerging treatment option for this disease, avoiding the morbidity of open approaches while providing excellent oncologic and functional outcomes. With overall survival rate at 2 years exceeding 80%, and local failure rate of less than 3%, patients receiving TORS report relatively good health-related quality of life (QOL) scores. The aim of the current review is to provide a summary of the current literature with regard to the oncologic and functional outcomes following treatment of OPSCC with TORS.
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Affiliation(s)
- Irit Duek
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Salem Billan
- The Oncology Institute, Rambam Health Care Campus, Haifa, Israel
| | - Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Laboratory for Applied Cancer Research, the Clinical Research Institute, Rambam Health Care Campus, The Technion, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
- The Laboratory for Applied Cancer Research, the Clinical Research Institute, Rambam Health Care Campus, The Technion, Haifa, Israel
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Dziegielewski PT, Teknos TN, Durmus K, Old M, Agrawal A, Kakarala K, Marcinow A, Ozer E. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg 2014; 139:1099-108. [PMID: 23576186 DOI: 10.1001/jamaoto.2013.2747] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially. OBJECTIVE To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC. DESIGN, PARTICIPANTS, AND SETTING This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center. INTERVENTIONS Primary surgical resection via TORS and neck dissection as indicated. MAIN OUTCOMES AND MEASURES Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected. RESULTS Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both). CONCLUSIONS AND RELEVANCE Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.
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Affiliation(s)
- Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus2Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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45
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Bastos de Souza TR, Pinto CAL, da Cunha Mercante AM, Nishimoto IN, Brasilino de Carvalho M, Kowalski LP. Long-term results of surgical treatment for advanced oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:1146-54. [PMID: 23897725 DOI: 10.1002/hed.23427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/29/2013] [Accepted: 06/26/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to review the oncologic and functional outcomes of patients with clinical stage III or IV squamous cell carcinoma (SCC) of the oropharynx submitted to tumor resection and neck dissection with or without postoperative radiotherapy (PORT). METHODS We conducted a retrospective review of medical charts of 256 consecutive patients. RESULTS Fatal postoperative complications were registered in 5 patients (1.9%). During follow-up, there were 74 local recurrences (29%), 27 neck recurrences (10.5%), and 19 distant metastases (7.4%). The 5-year overall survival (OS) was 43.0%. The Cox multivariate model identified pT3 and pT4, pN2 and pN3, and an intense lymphocytic infiltrate as independent prognostic markers for OS. The 5-year disease-free survival (DFS) rate was 54.5%. CONCLUSION Surgical treatment for oropharyngeal carcinoma can be performed with a low-risk of postoperative mortality but with a risk of long-term use of tracheostomy and feeding tubes.
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Affiliation(s)
- Tânia Regina Bastos de Souza
- Head and Neck Surgery and Otorhinolaryngology Department, Hospital A C Camargo, São Paulo, Brazil; Head and Neck Surgery Service, Hospital Heliopolis, São Paulo, Brazil
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Sumer BD, Goyal V, Truelson JM, Myers LL. Transoral robotic surgery and transoral laser microsurgery for oropharyngeal squamous cell cancer. J Robot Surg 2013; 7:377-83. [DOI: 10.1007/s11701-013-0408-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/30/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Baran D Sumer
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA.
| | - Varun Goyal
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - John M Truelson
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA
| | - Larry L Myers
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9035, USA
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47
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Transoral laser resection versus lip-split mandibulotomy in the management of oropharyngeal squamous cell carcinoma (OPSCC): a case match study. Eur Arch Otorhinolaryngol 2013; 271:367-72. [PMID: 23644937 DOI: 10.1007/s00405-013-2501-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/16/2013] [Indexed: 01/22/2023]
Abstract
The objective of this study was to compare transoral laser microsurgery (TLM) with lip-split mandibulotomy (LSM) and radial forearm free-flap reconstruction, for the resection of squamous cell carcinoma of the oropharynx (SCCOP). This study is designed as a case-control study matching 24 patients treated with TLM for SCCOP with those treated with LSM. Patients were matched by age (in 5-year epochs), sex, TNM stage, tumour sub site and type of neck dissection. Each group comprised 20 males and 4 females (mean age 56 years). Seven patients treated with TLM had an elective tracheostomy compared with all patients undergoing LSM. Moreover, the time for decanulation was reduced in patients undergoing tracheostomy for TLM. Although similar rates of patients were able to swallow to some degree on discharge, 29% of patients having LSM were discharged requiring enterostomy feeding compared with 4% of patients treated using TLM. Of those able to swallow on discharge, patients who had TLM resumed swallowing in half the time taken for those having LSM. Moreover, those treated with TLM remained in hospital for half the length of time than those treated with LSM. Due to these factors, overall cost for TLM is reduced in comparison with LSM. In comparison with LSM, TLM for the treatment of SCCOP results in fewer tracheostomies and shorter time to decanulation; a quicker recovery of swallowing function and a reduced length of hospital stay. As a result of this, treatment with TLM is on average cheaper. These factors should be considered when deciding on the surgical treatment of a patient with SCCOP.
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Luna-Ortiz K, Gómez-Pedraza A, Mosqueda-Taylor A. Soft palate preservation after tumor resection with transoral laser microsurgery. Med Oral Patol Oral Cir Bucal 2013; 18:e445-8. [PMID: 23229273 PMCID: PMC3668871 DOI: 10.4317/medoral.18634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/08/2012] [Indexed: 11/30/2022] Open
Abstract
Background: Management and preservation of the soft palate is dependent on clinical stage and tumor histology. However, available literature is scarce regarding the palate preservation with the use of laser CO2.
Objectives: We report the results obtained after management with laser surgery and soft palate preservation in three patients with salivary gland neoplasms.
Method: Three patients with minor salivary gland tumors were treated by means of transoral laser microsurgery. All tumors were assessed using magnetic resonance imaging. All tumors were >3 cm. Soft palate function was preserved and reconstruction was performed with primary closure. Patients began oral feeding the same day and were discharged after 24 h.
Conclusions: Transoral laser microsurgery is recommended for treatment of soft palate tumors. This treatment can be considered a better option when compared with other modalities such as radio- or chemoradiotherapy which require a longer time of treatment, are more expensive and tend to produce significant toxicity.
Key words:Laser CO2, neoplasms, salivary gland.
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Affiliation(s)
- Kuauhyama Luna-Ortiz
- Departamento de Cirugía de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico, DF, México
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Moore EJ, Hinni ML. Critical Review: Transoral Laser Microsurgery and Robotic-Assisted Surgery for Oropharynx Cancer Including Human Papillomavirus–Related Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2012.08.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hinni ML, Zarka MA, Hoxworth JM. Margin mapping in transoral surgery for head and neck cancer. Laryngoscope 2013; 123:1190-8. [DOI: 10.1002/lary.23900] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Michael L. Hinni
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
| | - Matthew A. Zarka
- Department of Laboratory Medicine and Pathology; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
| | - Joseph M. Hoxworth
- Department of Radiology; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
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