1
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Hughes RT, Levine BJ, May N, Shenker RF, Yang JH, Lanier CM, Frizzell BA, Greven KM, Waltonen JD. Survival and Swallowing Function after Primary Radiotherapy versus Transoral Robotic Surgery for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. ORL J Otorhinolaryngol Relat Spec 2023; 85:284-293. [PMID: 37647863 PMCID: PMC10631491 DOI: 10.1159/000531995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/23/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the impact of primary transoral robotic surgery (TORS) versus radiotherapy (RT) on progression-free survival (PFS), overall survival (OS), and 1-year swallowing function for patients with early-stage HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS Patients with stage I-II (AJCC 8th Ed.) HPV-associated OPSCC treated with TORS followed by risk-adapted adjuvant therapy or (chemo)radiotherapy between 2014 and 2019 were identified. PFS, OS, and swallowing outcomes including gastrostomy tube (GT) use/dependence, and Functional Oral Intake Scale (FOIS) change over 1 year were compared. RESULTS One hundred sixty-seven patients were analyzed: 116 treated with TORS with or without adjuvant RT and 51 treated with RT (50 chemoRT). The RT group had more advanced tumor/nodal stage, higher comorbidity, and higher rates of concurrent chemotherapy. There were no differences in 3-year PFS (88% TORS vs. 75% RT) or OS (90% vs. 81%) between groups, which persisted after adjusting for stage, age, and comorbidity. GT use/dependence rates were higher in the RT group. Mean (SD) FOIS scores in the TORS group were 6.9 (0.4) at baseline and 6.4 (1.0) at 1 year, compared with 6.7 (0.6) and 5.6 (1.7) for the RT group. Only clinical nodal stage was found to be significantly associated with FOIS change from baseline to 1 year. CONCLUSION There were no differences in PFS or OS between patients treated with primary TORS or RT for early-stage HPV-associated OPSCC. Clinical N2 status is associated with FOIS change at 1 year and may be the major factor affecting long-term swallowing function, irrespective of primary treatment modality.
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Affiliation(s)
- Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest University
School of Medicine, Winston Salem, NC, USA
| | - Beverly J. Levine
- Department of Social Sciences and Health Policy, Wake
Forest University School of Medicine, Winston Salem, NC, USA
| | - Nelson May
- Department of Otolaryngology, Wake Forest University School
of Medicine, Winston Salem, NC, USA
| | - Rachel F. Shenker
- Department of Radiation Oncology, Duke University School of
Medicine, Durham, NC, USA
| | - Jae H. Yang
- Department of Otolaryngology, Wake Forest University School
of Medicine, Winston Salem, NC, USA
| | - Claire M. Lanier
- Department of Radiation Oncology, Wake Forest University
School of Medicine, Winston Salem, NC, USA
| | - Bart A. Frizzell
- Department of Radiation Oncology, Wake Forest University
School of Medicine, Winston Salem, NC, USA
| | - Kathryn M. Greven
- Department of Radiation Oncology, Wake Forest University
School of Medicine, Winston Salem, NC, USA
| | - Joshua D. Waltonen
- Department of Otolaryngology, Wake Forest University School
of Medicine, Winston Salem, NC, USA
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2
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Kaur V, Rooney A, Horton B. Prognostic significance of extra-nodal extension and positive surgical margins in HPV positive oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103877. [PMID: 37030131 DOI: 10.1016/j.amjoto.2023.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Whether extra-nodal extension (ENE+) and surgical margin positivity (margin+) are poor prognostic factors in HPV-associated (HPV+) oropharyngeal carcinoma (OPC) remains uncertain. RESULTS Our study evaluated if microscopic ENE+ and/or margin+ are associated poorer recurrence free survival (RFS) and overall survival (OS) in HPV+ OPC. Patients were classified as high risk (ENE+ and/or margin+) or low risk (ENE- and margins-). Of a total of 176 patients HPV+ OPC, 81 underwent primary surgery and dad data on ENE and margin status. There was no statistically significant difference in RFS (p = 0.35) or OS (p = 0.13) for high-risk versus low-risk groups. Ongoing smoking (p = 0.023), alcohol use (p = 0.044) and advanced stage (p = 0.019) were associated with higher risk of recurrence. Only advanced stage (p-value <0.0001) was associated poorer overall survival. CONCLUSIONS The presence of ENE+ and/or margin+ was not an independent predictor of poor RFS or OS in HPV+ OPC.
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3
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Jackson RS, Stepan K, Bollig C, Sharma RK, Patel M, Massa S, Puram SV, Zevallos JP, Pipkorn P, Zenga J. Outcomes of HPV-Negative Oropharyngeal Cancer Treated With Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2021; 165:682-689. [PMID: 33752484 DOI: 10.1177/0194599821996647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing secondary to human papillomavirus (HPV)-related disease. Despite this, outcomes of patients with HPV-negative OPSCC undergoing transoral robotic surgery (TORS) are largely unknown. STUDY DESIGN Analysis of the National Cancer Database (NCDB). SETTING Not applicable. METHODS The 2015 participant user file from the NCDB was analyzed between 2010 and 2015 for patients with OPSCC who underwent TORS and neck dissection. Kaplan-Meier survival analysis was used to estimate overall survival of the study population. Univariable Cox survival analyses was used to determine significant associations between demographic, tumor, and treatment characteristics and overall survival (OS). RESULTS There were 164 patients (124 male and 40 female) with a mean age of 58 years (30-89 years). Median follow-up was 34 months. Five-year OS was 78% (95% CI, 70%-86%). Patients with early stage disease (pT1-2, N0-1) had significantly improved OS compared to patients with advanced T- or N-stage disease (log-rank 0.011; 5-year OS: 88% [95% CI, 78%-98%] vs 66% [95% CI, 50%-82%]). CONCLUSION Very few patients in the NCDB underwent TORS for HPV-negative OPSCC, but those who did had favorable outcomes, especially in early stage disease. Based on these findings, TORS may be considered in the treatment algorithm for patients with HPV-negative OPSCC. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Katelyn Stepan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Craig Bollig
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rahul K Sharma
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mihir Patel
- Department of Otolaryngology-Head and Neck Surgery, Winship Cancer Institute at Emory, Atlanta, Georgia, USA
| | - Sean Massa
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Oncological outcome following initiation of treatment for stage III and IV HPV negative oropharyngeal cancers with transoral robotic surgery (TORS). Eur J Surg Oncol 2019; 45:2137-2142. [DOI: 10.1016/j.ejso.2019.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
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5
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Goel AN, Sangar S, Mukdad L, Heaton CM, Ryan WR, Wang MB, Long JL, St John MA. Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate-risk features. Head Neck 2019; 41:3177-3186. [PMID: 31107584 DOI: 10.1002/hed.25808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Survival outcomes for adjuvant chemoradiotherapy (aCRT) and adjuvant radiotherapy (aRT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate-risk features. METHODS We identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate-risk feature: pT3-T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of aCRT use and covariables impacting overall survival. RESULTS aCRT was commonly used for both human papillomavirus (HPV)-positive (62.0%) and HPV-negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted aCRT utilization. There was no significant survival benefit associated with aCRT vs aRT in HPV-positive (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.62-1.38; P = .71) or HPV-negative (HR, 0.75; 95% CI, 0.51-1.10; P = .15) disease. CONCLUSIONS Despite high rates of utilization, aCRT is not associated with better survival vs aRT for OPSCC with intermediate-risk features, including HPV-negative tumors.
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Affiliation(s)
- Alexander N Goel
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Sangar
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Laith Mukdad
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Chase M Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Research Service, Department of Veterans Affairs, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California
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6
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da Silva GM, Portas J, López RVM, Côrrea DF, Arantes LMRB, Carvalho AL. Study of Dysphagia in Patients with Advanced Oropharyngeal
Cancer Subjected to an Organ Preservation Protocol Based on
Concomitant Radiotherapy and Chemotherapy. Asian Pac J Cancer Prev 2019; 20:977-982. [PMID: 30912631 PMCID: PMC6825780 DOI: 10.31557/apjcp.2019.20.3.977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Organ preservation protocol (based on chemo-radiotherapy) for oropharyngeal tumors include dysphagia as a possible sequel leading to function impairment and changes in patient’s quality of life. Objectives: The aim of this study is to assess dysphagia severity after treatment in advanced oropharyngeal cancer patients treated with concurrent chemo-radiation. Methods: This prospective cross-sectional study included 64 participants who had been disease free for at least six months after primary treatment. Dysphagia severity was assessed by fibre-optic endoscopic evaluation of swallowing (FEES) and the Dysphagia Outcome and Severity Scale (DOSS); the occurrence of penetration/aspiration during swallowing was also investigated. All participants also completed the M. D. Anderson Dysphagia Inventory (MDADI). The correlation of FEES results with clinical-demographic variables and MDADI scores was assessed. Descriptive analysis was performed, and qualitative variables were compared using either the chi-square or Fisher’s exact test. Results: FEES revealed silent aspiration in 18.8% of the patients. Approximately 6.3% of the patients exhibited severe dysphagia (scores 1-2 in DOSS). Dysphagia severity was significantly associated with the MDADI physical domain scores. The participants with scores 5-7 in DOSS (no or mild dysphagia) exhibited less limitations in the MDADI physical domain (p=0.015). Conclusions: Silent aspiration was detected in one of every five patients treated with concurrent chemo-radiotherapy; almost half of the patients exhibit at least moderate dysphagia. Assessment of the participant’s quality of life via the MDADI revealed an association between the physical domain scores and dysphagia severity.
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Affiliation(s)
| | - Juliana Portas
- Speech Language Pathology Department, Barretos Cancer Hospital, Barretos – SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos – SP, Brazil
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7
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Prosiegel M, Weber S. Mit Schluckstörungen assoziierte Erkrankungen. DYSPHAGIE 2018:69-133. [DOI: 10.1007/978-3-662-56132-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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8
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Vangelov B, Venchiarutti RL, Smee RI. Critical Weight Loss in Patients With Oropharynx Cancer During Radiotherapy (± Chemotherapy). Nutr Cancer 2017; 69:1211-1218. [DOI: 10.1080/01635581.2017.1367943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
- Department of Nutrition and Dietetics, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rebecca L. Venchiarutti
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
| | - Robert I. Smee
- Department of Radiation Oncology, The Prince of Wales Hospital Cancer Centre, Randwick, New South Wales, Australia
- University of New South Wales Clinical Teaching School, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
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9
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Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): A prospective trial. Oral Oncol 2017; 69:80-83. [DOI: 10.1016/j.oraloncology.2017.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 11/23/2022]
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10
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Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S176-S180. [PMID: 27841134 PMCID: PMC4873894 DOI: 10.1017/s0022215116000608] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group.
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11
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Wilkie MD, Upile NS, Lau AS, Williams SP, Sheard J, Helliwell TR, Robinson M, Rodrigues J, Beemireddy K, Lewis-Jones H, Hanlon R, Husband D, Shenoy A, Roland NJ, Jackson SR, Bekiroglu F, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach. Head Neck 2016; 38:1263-70. [PMID: 27042800 DOI: 10.1002/hed.24432] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/27/2015] [Accepted: 01/13/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM). METHODS A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics. RESULTS Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%. CONCLUSION To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263-1270, 2016.
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Affiliation(s)
- Mark D Wilkie
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Navdeep S Upile
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Andrew S Lau
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Stephen P Williams
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jon Sheard
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Tim R Helliwell
- Department of Pathology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle, United Kingdom
| | - Jennifer Rodrigues
- Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Krishna Beemireddy
- Department of Anaesthetics, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Huw Lewis-Jones
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Rebecca Hanlon
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - David Husband
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Aditya Shenoy
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Nicholas J Roland
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Shaun R Jackson
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Fazilet Bekiroglu
- Department of Oral and Maxillofacial Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sankalap Tandon
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Terence M Jones
- Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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12
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Sload R, Silver N, Jawad BA, Gross ND. The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma. Curr Oncol Rep 2016; 18:53. [DOI: 10.1007/s11912-016-0541-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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INFANTE-COSSIO PEDRO, GONZALEZ-CARDERO EDUARDO, LOPEZ-MARTOS RICARDO, NUÑEZ-VERA VICTORIA, OLMOS-JUAREZ ERIKA, RUIZ-MOYA ALEJANDRO, HARO-LUNA JUANJOSE, TORRES-CARRRANZA EUSEBIO. Infrahyoid flap in oropharyngeal reconstruction following carcinoma resection: A study of 6 patients and literature review. Oncol Lett 2016; 11:3493-3500. [PMID: 27123141 PMCID: PMC4841066 DOI: 10.3892/ol.2016.4429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/15/2016] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to describe the techniques used and the results obtained with the infrahyoid flap for the reconstruction of medium-sized oropharyngeal defects following resection for advanced squamous cell cancer. During a period of 1 year, six patients with oropharyngeal defects were reconstructed using the infrahyoid flap. The tumor characteristics, location and size of the defect, resective and reconstructive techniques employed and the complications and outcomes of the speech and swallowing functions, as identified in the follow-up visits every 3 months, were evaluated. All flaps were performed simultaneously in association with tumoral excision and ipsilateral supraomohyoid neck dissection. The mean size of the skin paddle was 7.0×3.5 cm. The donor site was primarily sutured. The postoperative course was uneventful and all flaps were viable. One case of marginal skin paddle loss occurred without affecting the survival of the flap. Five patients received postoperative radiotherapy and one patient received concurrent postoperative chemotherapy. During the follow-up period (mean, 63 months), all patients showed excellent oral swallowing. Speech was excellent in five patients and in one patient speech was classified as good. The aesthetic results of the cervical donor site were good. Based on the present case report and the literature review, the infrahyoid flap is a simple and safe procedure for the reconstruction of the oropharynx, with a high success rate, minimal donor site morbidity and good aesthetic and functional results. The infrahyoid flap is a valid surgical option that may be considered in selected oncological patients undergoing reconstruction of medium-size oropharyngeal defects.
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Affiliation(s)
- PEDRO INFANTE-COSSIO
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - EDUARDO GONZALEZ-CARDERO
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - RICARDO LOPEZ-MARTOS
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - VICTORIA NUÑEZ-VERA
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - ERIKA OLMOS-JUAREZ
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - ALEJANDRO RUIZ-MOYA
- Department of Plastic and Reconstructive Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
| | - JUAN-JOSE HARO-LUNA
- Department of Oral and Maxillofacial Surgery, Santa Lucía Hospital, Cartagena, Murcia 30202, Spain
| | - EUSEBIO TORRES-CARRRANZA
- Department of Oral and Maxillofacial Surgery, Virgen Del Rocío University Hospital, University of Seville, Seville, Seville 41013, Spain
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Mazarro A, de Pablo A, Puiggròs C, Velasco MM, Saez M, Pamias J, Bescós C. Indications, reconstructive techniques, and results for total glossectomy. Head Neck 2016; 38 Suppl 1:E2004-10. [DOI: 10.1002/hed.24369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/30/2015] [Accepted: 11/25/2015] [Indexed: 01/03/2023] Open
Affiliation(s)
- Alejandro Mazarro
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Alba de Pablo
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | | | - Mª Mercedes Velasco
- Department of Phoniatry and Logopedy - Rehabilitation Service; Hospital Vall d'Hebron; Barcelona Spain
| | - Manel Saez
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Jorge Pamias
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
| | - Coro Bescós
- Oral and Maxillofacial Department; Hospital Vall d'Hebron; Barcelona Spain
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15
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Asakage T, Ando M, Yoshida M, Saito Y, Omura G, Yamasoba T. [Retrospective Study of Induction Chemotherapy and Concurrent Chemoradiation Therapy for Oropharyngeal Cancer]. ACTA ACUST UNITED AC 2016; 118:1226-32. [PMID: 26727822 DOI: 10.3950/jibiinkoka.118.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We carried out this study to clarify the treatment outcomes and problems associated with induction chemotherapy (using taxotere, cisplatin and 5-FU [TPF therapy]) and chemoradiotherapy in patients with oropharyngeal cancer. The data of 44 patients receiving their initial treatment for oropharyngeal cancer (including 2, 9 and 33 patients with stage II, stage III and stage IV disease, respectively, and 31, 8 and 3 patients with side wall, front wall and upper wall (soft palate and uvula) involvement) were examined. Of the 44 patients, 33 received induction chemotherapy and 11 received chemoradiotherapy. The feasibility, incidence of neutropenia, response rate, and 3 year disease-specific survival rate in the induction chemotherapy group vs. chemoradiotherapy group were 70%, 88%, 82% and 73%, respectively, vs. 63%, 91%, 82% and 55%, respectively. A statistically significant difference in the 3-year disease-specific survival rate was seen between the p16-positive and p16-negative patients in the induction chemotherapy group: while the rate was 100% in the p16-positive patients, it was only 51% in the p16-negative patients (p=0.004). Of the patients undergoing chemoradiotherapy, 3 developed mandibular osteomyelitis, which was considered as one of the important problems associated with this therapy.
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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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López F, Llorente JL, Álvarez-Marcos C, Morato M, Suárez C, Rodrigo JP. Outcomes Following Transoral Resection of Oropharyngeal Squamous Cell Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Kendall KA, Tanner K, Kosek SR. Timing of events during deglutition after chemoradiation therapy for oropharyngeal carcinoma. Head Neck 2014; 37:1193-9. [DOI: 10.1002/hed.23735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 01/27/2014] [Accepted: 04/29/2014] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Kristine Tanner
- Department of Communication Disorders; Brigham Young University; Provo Utah
- Voice Disorders Center; University of Utah; Salt Lake City Utah
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López F, Llorente JL, Álvarez-Marcos C, Morato M, Suárez C, Rodrigo JP. [Outcomes following transoral resection of oropharyngeal squamous cell carcinoma]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 66:74-82. [PMID: 24958186 DOI: 10.1016/j.otorri.2014.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/01/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral surgery (TOS) as the primary treatment for oropharyngeal carcinoma. METHODS We reviewed 43 previously untreated patients with oropharyngeal carcinoma, who were treated with TOS. Distribution of the primary tumor site was: tonsil (52%), soft palate (23%), base of the tongue (21%) and posterior wall (4%). Eight patients had a stage I disease, 9 had a stage II disease, 7 had a stage III disease, 16 had a stage IVA, and 3 had stage IVB disease. Eighteen patients underwent postoperative radiotherapy. Records of these patients were reviewed to obtain measures such as local and regional control, overall and disease-specific survival, and speech and swallowing function. RESULTS The overall recurrence rate was 44%, and the local recurrence rate was 18%. The 5-year overall survival and disease-specific survival rates were 55% and 66%, respectively. Five-year disease-specific survival rates by site were as follows: 100%, 85%, 44%, and 30% for posterior wall, tonsil, soft palate and base of the tongue, respectively. Five-year estimates for local control were 100%, 90%, and 0% for palate, tonsil and for base of the tongue tumors, respectively. All of the patients preserved the larynx and live without tracheotomy and oral alimentation was successfully without feeding tube. CONCLUSIONS TOS as the primary treatment approach offers a surgical alternative for treatment of the primary oropharyngeal tumor, in the era of chemoradiation therapy. This approach confers a good local control and functional outcomes.
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Affiliation(s)
- Fernando López
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - José L Llorente
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - César Álvarez-Marcos
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Marta Morato
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carlos Suárez
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan P Rodrigo
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Flavill E, Fang YV, Miles B, Truelson J, Perkins S. Induction chemotherapy followed by concurrent chemoradiotherapy for advanced stage oropharyngeal squamous cell carcinoma with HPV and P16 testing. Ann Otol Rhinol Laryngol 2014; 123:365-73. [PMID: 24687594 DOI: 10.1177/0003489414526685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to report our experience with advanced stage oropharyngeal squamous cell carcinoma treated sequentially with induction chemotherapy followed by concurrent chemoradiotherapy. METHODS Retrospective chart review identified 49 eligible patients with advanced stage oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiotherapy. HPV and p16(INK4A) testing was performed on pathology specimens. Follow-up of over 11 months was required unless a death or treatment failure occurred before that time. RESULTS Treatment with induction chemotherapy followed by concurrent chemoradiotherapy resulted in 44/48 (90%) complete durable response. One death occurred from pulmonary embolism. Toxicity profiles were comparable to other published data. Average follow-up was 3.9 years. Oncologic failure rates among subgroups showed 5.7% failure for HPV+/p16+ cancer, 9.1% failure for HPV-/p16+ cancer, 100% failure for HPV-/p16- cancer, 0% failure for nonsmokers, and 17.9% failure for smokers. CONCLUSIONS This study showed favorable outcomes in terms of durable oncologic response and acceptable toxicity profiles. It is notable that 36/49 patients were HPV+/p16+ and 11/49 were HPV-/p16+. Only 2 patients were HPV-/p16-, and both died as a result of oncologic failures. This highlights the importance of obtaining HPV and p16 testing in studies evaluating the efficacy of treatments for oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- Eric Flavill
- Department of Otolaryngology/Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Virani A, Kunduk M, Fink DS, McWhorter AJ. Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck 2014; 37:162-70. [PMID: 24347440 DOI: 10.1002/hed.23570] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function. METHODS Fifty patients were recruited prospectively to 2 groups (the exercise group, n = 26 and the repetitive swallow group, n = 24). Functional Oral Intake Scale (FOIS) scores and percutaneous endoscopic gastrostomy (PEG) placements were compared at posttreatment and at 3 months. RESULTS The exercise group eliminated significantly more PEG tubes at 3 months posttreatment compared to the swallow group (16% vs 50%). Among patients who received both radiation and chemotherapy, the exercise group had significantly less PEG tubes immediately posttreatment as well as 3 months posttreatment (35% and 10%), compared to the swallow group (69% and 50%). CONCLUSION Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties.
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Affiliation(s)
- Aneesha Virani
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana
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Technical challenges of sparing infrahyoid swallowing organs at risk in oropharynx squamous cell cancer treated with IMRT. Med Dosim 2014; 39:146-51. [PMID: 24440166 DOI: 10.1016/j.meddos.2013.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 11/15/2013] [Accepted: 11/15/2013] [Indexed: 11/24/2022]
Abstract
This study reports clinical performance in the sparing of infrahyoid swallowing organs at risk (SWOARs) in oropharynx cancer intensity-modulated radiation therapy (IMRT) plans. Rates of meeting dose-volume planning goals are reported and compared with geometry-based estimates of what is achievable. This study also develops 3 measures of target-SWOAR geometry and tests their usefulness in providing geometry-based dose-volume planning goals. A total of 50 oropharynx cancer IMRT plans were reviewed. Success rates in meeting institutional dose-volume goals were determined for the glottic larynx (G), postcricoid pharynx (P), and esophagus (E). The following 3 measures of target-SWOAR geometry were investigated as methods of identifying geometry-based planning goals: presence of gross disease in neck levels 3 to 4, target-SWOAR overlap, and a 3-dimensional (3D) measure of target-SWOAR geometry. Locally advanced disease was predominant in this patient population with target volumes overlapping SWOARs in 68% to 98% of cases. Clinical rates of success in meeting dose-volume goals varied by SWOAR (16% to 82%) but compared well with estimated potentially achievable rates in most cases (14% average difference between clinical and potential). Cases grouped by the presence of levels 3 to 4 neck nodes or target-SWOAR overlap did not have significantly different SWOAR doses. Cases grouped using a 3D measure of target-SWOAR geometry differed significantly, providing useful geometry-based planning goals (e.g., mean Glottis dose <45Gy was achieved 19%, 44%, or 81% of the time in each of 3 groups). This study describes the technical challenge of sparing SWOARs and investigates several potential methods for grouping cases to assist with treatment plan evaluation. Quantifying the 3-D relationship between the targets and SWOARs is a promising way of approaching this complex problem. Data presented in this paper may be useful to evaluate treatment plans using objective geometry-based goals.
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Kendall KA, Kosek SR, Tanner K. Quality-of-life scores compared to objective measures of swallowing after oropharyngeal chemoradiation. Laryngoscope 2013; 124:682-7. [DOI: 10.1002/lary.24344] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | - Steven R. Kosek
- Department of Speech Language Pathology; Minneapolis VA Medical Center; Minneapolis Minnesota
| | - Kristine Tanner
- Voice Disorders Center; University of Utah; Salt Lake City Utah
- Department of Communication Disorders; Brigham Young University; Provo Utah U.S.A
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Loevner LA, Learned KO, Mohan S, O’Malley BW, Scanlon MH, Rassekh CH, Weinstein GS. Transoral Robotic Surgery in Head and Neck Cancer: What Radiologists Need to Know about the Cutting Edge. Radiographics 2013; 33:1759-79. [DOI: 10.1148/rg.336135518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chia SH, Gross ND, Richmon JD. Surgeon Experience and Complications with Transoral Robotic Surgery (TORS). Otolaryngol Head Neck Surg 2013; 149:885-92. [DOI: 10.1177/0194599813503446] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To investigate surgeon preferences for perioperative management of transoral robotic surgery (TORS) and explore the frequency of postoperative complications. Study Design Retrospective survey. Setting Multi-institutional. Subjects and Methods An electronic survey was sent to over 300 TORS-trained surgeons in the United States identified by Intuitive Surgical, Inc. Participation was voluntary and solicited by email invitations to participate 3 times over a 1-month period. Results A total of 2015 procedures were reported by 45 respondent TORS-trained surgeons: 67% academic, 33% nonacademic. A minority of TORS procedures (n = 214, 10.6%) were performed on previously irradiated patients. Neck dissections were performed concurrently (58%) or staged (42%). Fewer than 6% of TORS procedures required tracheotomy or reconstruction. Most surgeons (62%) initiated oral intake on postoperative day 0-1. Of the patients who required readmission, bleeding (n = 62, 3.1%) was the most common cause followed by dehydration (n = 26, 1.3%). Other complications of surgery included tooth injury (n = 29, 1.4%), percutaneous endoscopic gastrostomy (PEG) dependency >6 months (n = 21, 1.0%), temporary hypoglossal nerve injury (n = 18, 0.9%), and lingual nerve injury (n = 11, 0.6%). A total of 6 deaths (0.3%) were reported within 30 days of TORS. All reported deaths were due to postoperative hemorrhage. The complication rate decreased significantly with higher surgeon case volume (>50 cases). Conclusions TORS is associated with a low major complication rate, early initiation of oral intake, and a low rate of long-term PEG dependency. Postoperative hemorrhage was the most common cause of hospital readmission and postoperative mortality.
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Affiliation(s)
- Stanley H. Chia
- Department of Otolaryngology, Medstar Washington Hospital Center, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Neil D. Gross
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeremy D. Richmon
- Department of Otolaryngology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Navach V, Zurlo V, Calabrese L, Massaro MA, Bruschini R, Giugliano G, Ansarin M, Chiesa F. Total glossectomy with preservation of the larynx: oncological and functional results. Br J Oral Maxillofac Surg 2013; 51:217-23. [DOI: 10.1016/j.bjoms.2012.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/16/2012] [Indexed: 10/28/2022]
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Results of transoral laser microsurgery in 102 patients with squamous cell carcinoma of the tonsil. Eur Arch Otorhinolaryngol 2012; 270:2299-306. [PMID: 23274878 PMCID: PMC3699702 DOI: 10.1007/s00405-012-2335-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/14/2012] [Indexed: 12/13/2022]
Abstract
The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13% presented with stage I and II (UICC/AJCC 2002) tumors and 87% with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95%) and with (66%) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan-Meier local and loco-regional control was 78% for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan-Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59% for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.
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Haughey BH, Sinha P. Prognostic factors and survival unique to surgically treated p16+ oropharyngeal cancer. Laryngoscope 2012; 122 Suppl 2:S13-33. [DOI: 10.1002/lary.23493] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sinha P, Lewis JS, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer 2011; 118:3519-30. [DOI: 10.1002/cncr.26671] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 11/11/2022]
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Chen AM, Farwell DG, Lau DH, Li BQ, Luu Q, Donald PJ. Radiation Therapy in the Management of Head-and-Neck Cancer of Unknown Primary Origin: How Does the Addition of Concurrent Chemotherapy Affect the Therapeutic Ratio? Int J Radiat Oncol Biol Phys 2011; 81:346-52. [DOI: 10.1016/j.ijrobp.2010.06.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 06/01/2010] [Accepted: 06/03/2010] [Indexed: 11/30/2022]
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Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2011; 19:144-9. [DOI: 10.1097/moo.0b013e3283457616] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haughey BH, Hinni ML, Salassa JR, Hayden RE, Grant DG, Rich JT, Milov S, Lewis JS, Krishna M. Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: A united states multicenter study. Head Neck 2011; 33:1683-94. [PMID: 21284056 DOI: 10.1002/hed.21669] [Citation(s) in RCA: 264] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/24/2010] [Accepted: 10/04/2010] [Indexed: 11/10/2022] Open
Affiliation(s)
- Bruce H Haughey
- Department of Otolaryngology-Head and Neck Surgery Washington University School of Medicine, St. Louis, Missouri, USA.
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Yamashita T, Tomifuji M, Araki K, Kurioka T, Shiotani A. Endoscopic transoral oropharyngectomy using laparoscopic surgical instruments. Head Neck 2010; 33:1315-21. [DOI: 10.1002/hed.21604] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/17/2010] [Accepted: 07/30/2010] [Indexed: 11/10/2022] Open
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Chen AM, Li BQ, Jennelle RLS, Lau DH, Yang CC, Courquin J, Vijayakumar S, Purdy JA. Late esophageal toxicity after radiation therapy for head and neck cancer. Head Neck 2010; 32:178-83. [PMID: 19536858 DOI: 10.1002/hed.21164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the incidence of esophageal toxicity after radiation therapy for head and neck cancer. METHODS The records of 211 patients treated by radiation therapy for head and neck cancer were reviewed to identify those with dysphagia lasting more than 90 days after therapy. Late toxicity criteria established by the Radiation Therapy Oncology Group were used to score the symptoms. RESULTS The incidence of grade 3+ esophageal toxicity at 3 and 6 months was 30% and 19%, respectively. The rate of gastrotomy-tube dependence at 3 and 6 months was 20% and 11%, respectively. Hypopharyngeal and unknown primary site (p = .01, for both), T4 disease (p = .01), and the use of concurrent chemotherapy (p = .001) were associated with grade 3+ esophageal toxicity and stricture formation. CONCLUSION A significant proportion of patients exhibit symptoms of esophageal toxicity after radiation therapy for head and neck cancer. Therefore, preventive strategies need further investigation.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California 95817, USA.
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Rich JT, Milov S, Lewis JS, Thorstad WL, Adkins DR, Haughey BH. Transoral laser microsurgery (TLM) +/- adjuvant therapy for advanced stage oropharyngeal cancer: outcomes and prognostic factors. Laryngoscope 2010; 119:1709-19. [PMID: 19572271 DOI: 10.1002/lary.20552] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Document survival, prognostic variables, and functional outcomes of patients with AJCC stage III or IV oropharyngeal cancer, treated with transoral laser microsurgery (TLM) +/- adjuvant therapy. STUDY DESIGN Analysis of prospectively assembled data pertaining to the above-described patient cohort. METHODS Patients treated with TLM for AJCC stage III or IV oropharyngeal cancer at Washington University School of Medicine from 1996 to 2006 were followed for a minimum of 2 years. Recurrence, survival, functional, and human papilloma virus data were analyzed. RESULTS Eighty-four patients met inclusion criteria. Mean follow-up was 52.6 months. Overall AJCC stages were: III 15% and IV 85%. T stages were T1-2, 74%; T3-4, 26%. Eighty-three patients underwent neck dissection, 50 received adjuvant radiotherapy, and 28 received adjuvant chemoradiotherapy. Overall survival at 2 and 5 years was 94% and 88%, respectively. Disease-specific survival at 2 and 5 years was 96% and 92%, respectively. Six patients recurred (7%): locally (one), regionally (four), and distant (five). T stage, positive margins, and p16 status significantly impacted survival. The addition of adjuvant chemotherapy in high-risk patients did not significantly impact survival. Five patients (6%) had major surgical complications, but without mortality. Eighty-one percent of patients had acceptable swallowing function at last follow-up. Immediately postoperatively, 17% required G-tubes, which dropped to 3.4% of living patients at 3 years. CONCLUSIONS In this population, our findings validate TLM +/- adjuvant therapy as a highly effective strategy for survival, locoregional control, and swallowing recovery in AJCC stage III and IV oropharyngeal cancer. Our finding also show that p16 positivity improves survival.
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Affiliation(s)
- Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Moore EJ, Olsen KD, Kasperbauer JL. Transoral robotic surgery for oropharyngeal squamous cell carcinoma: A prospective study of feasibility and functional outcomes. Laryngoscope 2009; 119:2156-64. [DOI: 10.1002/lary.20647] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Changes in laryngeal sensation evaluated with a new method before and after radiotherapy. Eur Arch Otorhinolaryngol 2009; 267:811-6. [PMID: 19705139 PMCID: PMC2844527 DOI: 10.1007/s00405-009-1069-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 08/05/2009] [Indexed: 11/23/2022]
Abstract
Radiotherapy of the laryngopharynx sometimes leads to functional disabilities including swallowing dysfunction. One of the reasons for these disabilities is a deterioration of laryngeal sensation. Laryngeal sensation is an important factor in swallowing, but quantitative evaluation of laryngeal sensation has been difficult. In this study, we evaluated changes in laryngeal sensation before and after radiotherapy for laryngeal and hypopharyngeal cancer, using a flexible laryngoscope and probes. This study was conducted in 12 patients, 8 with laryngeal cancer and 4 with hypopharyngeal cancer, who received radiotherapy alone or chemoradiotherapy at our medical centre. Measurements were performed using a 3.3-mm-diameter flexible laryngoscope with a probe port and four types of probes with 0.06-, 0.13-, 0.20-, and 0.30-mm nylon filaments attached to a wire tip. Sensation was evaluated at the tip of the epiglottis and the arytenoid region. Measurements were performed before radiotherapy, 1, 3 months, and 1 year after completion of radiotherapy. Sensation of the epiglottis and arytenoid deteriorated significantly 1 and 3 months after radiotherapy compared with before radiotherapy. Laryngeal sensation recovered in most cases within 1 year after radiotherapy. The present study clearly demonstrates the deterioration of laryngeal sensation with radiotherapy.
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