Details

Autor(en) / Beteiligte

• Yver, Christina M.
• Shimunov, David
• Weinstein, Gregory S.
• Rajasekaran, Karthik
• Cannady, Steven B.
• Lukens, John N.
• Lin, Alexander
• Swisher-McClure, Samuel
• Cohen, Roger B.
• Aggarwal, Charu
• Bauml, Joshua M.
• Loevner, Laurie A.
• Newman, Jason G.
• Chalian, Ara A.
• Rassekh, Christopher H.
• Basu, Devraj
• O'Malley, Bert W.
• Brody, Robert M.

Titel

Oncologic and survival outcomes for resectable locally-advanced HPV-related oropharyngeal cancer treated with transoral robotic surgery

Ist Teil von

• Oral oncology, 2021-07, Vol.118, p.105307-105307, Article 105307

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2021

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• •Advanced HPV+ OPSCC treated with TORS achieves survival comparable to that of early-stage tumors.•Up-front TORS allows avoidance of adjuvant chemoradiation in advanced HPV+ OPSCC.•Patients should not be excluded from consideration for TORS solely based on advanced tumor size. To determine whether up-front trans-oral robotic surgery (TORS) for clinically-staged locally-advanced human papillomavirus (HPV)-related oropharyngeal cancer is associated with oncologic and survival outcomes comparable to early-stage (cT1/T2) tumors. Retrospective cohort study of 628 patients with HPV-related oropharyngeal cancer who underwent up-front TORS from 2007 to 2017. Patients were stratified into two cohorts based on early-stage (cT1/2) versus locally-advanced (cT3/4) tumor at presentation. We identified 589 patients who presented with early-stage tumors, and 39 patients with locally-advanced tumors. Of these, 73% of patients required adjuvant radiation, and 33% required adjuvant chemoradiation. There was no significant difference in the administration of adjuvant radiation or chemoradiation between the two cohorts. Patients in the locally-advanced disease cohort were significantly more likely to have Stage II/III disease by clinical and pathologic criteria by American Joint Committee on Cancer 8th edition criteria (p < 0.001). However, there was no significant difference in 5-year overall survival (OS) or recurrence-free survival (RFS) based on Kaplan-Meier survival estimates between the two cohorts (p = 0.75, 0.6, respectively), with estimated OS of 91% at 5 years, and estimated RFS of 86% at 5 years across the study population. Up-front TORS offers favorable survival outcomes for appropriately selected locally-advanced cases of HPV-related oropharyngeal cancer. Furthermore, up-front TORS is comparably effective in allowing avoidance of adjuvant therapy, particularly chemotherapy, in both cT1/T2 and locally-advanced HPV-positive oropharyngeal cancer. In the absence of clear technical contraindication to surgery, cT3/T4 classification should not be considered an absolute contraindication to surgery.