Utility of up‐front transoral robotic surgery in tailoring adjuvant therapy

• DOI: 10.1002/hed.24390
• Publication Date: 2016-05-26T08:57:59Z
• Authors: Neil Gildener–Lea...; Jeehong Kim; Shira Abberbock; Garret W. Choby; Rajarsi Mandal; Umamaheswar Duvvuri; Robert L. Ferris; Seungwon Kim
• Keywords: Adult; Male; Academic Medical Centers; Analysis of Variance; Chi-Square Distribution; Laryngectomy; Chemoradiotherapy, Adjuvant; Kaplan-Meier Estimate; Middle Aged; Disease-Free Survival; Patient Care Planning; Cohort Studies; Oropharyngeal Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Humans; Female; Neoplasm Invasiveness; Aged; Neoplasm Staging

AbstractBackgroundThe purpose of this study was to describe how the up‐front transoral robotic surgery (TORS) approach could be used to individually tailor adjuvant therapy based on surgical pathology.MethodsBetween January 2009 and December 2013, 76 patients received TORS for oropharyngeal squamous cell carcinoma (OPSCC). Clinical predictors of adjuvant therapy were analyzed and comparisons were made between recommended treatment guidelines for up‐front surgery versus definitive nonsurgical approaches.ResultsAdvanced N classification, human papillomavirus (HPV)‐positive tumor, extracapsular spread (ECS; 26 of 76), perineural invasion (PNI; 14 of 76), and positive margins (7 of 76) were significant predictors of adjuvant chemoradiotherapy (CRT) (p < .05). Up‐front TORS deintensified adjuvant therapy; 76% of stage I/II and 46% of stage III/IV patients avoided CRT. Conversely, pathologic staging resulted in 33% of patients who would have received radiotherapy (RT) alone based on clinical staging, to be intensified to receive adjuvant CRT.ConclusionThe TORS approach deintensifies adjuvant therapy and provides valuable pathologic information to intensify treatment in select patients. TORS may be less effective in deintensification of adjuvant therapy in patients with clinically advanced N classification disease. © 2016 Wiley Periodicals, Inc. Head Neck 38:1201–1207, 2016