Preferences and utilities for health states after treatment for oropharyngeal cancer: Transoral robotic surgery versus definitive (chemo)radiotherapy

Head & Neck ◽  
2014 ◽  
Vol 36 (7) ◽  
pp. 923-933 ◽  
Author(s):  
John R. de Almeida ◽  
Nathaniel L. Villanueva ◽  
Alan J. Moskowitz ◽  
Brett A. Miles ◽  
Marita S. Teng ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery ◽  
Health States

scholarly journals Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

2016 ◽  
Vol 142 (7) ◽  
pp. 691 ◽  
Author(s):  
Arun Sharma ◽  
Sapna Patel ◽  
Fred M. Baik ◽  
Grant Mathison ◽  
Brendan H. G. Pierce ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Modern Treatment Outcomes for Early T-Stage Oropharyngeal Cancer Treated With Intensity-modulated Radiation Therapy at a Tertiary Care Institution

2020 ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract BackgroundTransoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.MethodsConsecutive cases of early T stage (T1-T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014-2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the CTCAE criteria.ResultsA total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p=0.0026). ConclusionsPrimary RT or CRT provides outstanding survival for early T-stage HPV-positive disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

Evaluating dysphagia and xerostomia outcomes following transoral robotic surgery for patients with oropharyngeal cancer

Head & Neck ◽  
2021 ◽  
Author(s):  
Mitesh P. Mehta ◽  
Rebecca Prince ◽  
Zeeshan Butt ◽  
Bryce E. Maxwell ◽  
Brittni N. Carnes ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Dysphagia After Primary Transoral Robotic Surgery With Neck Dissection vs Nonsurgical Therapy in Patients With Low- to Intermediate-Risk Oropharyngeal Cancer

2019 ◽  
Vol 145 (11) ◽  
pp. 1053 ◽  
Author(s):  
Katherine A. Hutcheson ◽  
Carla L. Warneke ◽  
Christopher M. K. L. Yao ◽  
Jhankruti Zaveri ◽  
Baher E. Elgohari ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Neck Dissection ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery ◽  
Intermediate Risk ◽  
Nonsurgical Therapy

scholarly journals Development of an online, patient-centred decision aid for patients with oropharyngeal cancer in the transoral robotic surgery era

2017 ◽  
Vol 24 (5) ◽  
pp. 318 ◽  
Author(s):  
J.S. Lam ◽  
G.M. Scott ◽  
D.A. Palma ◽  
K. Fung ◽  
A.V. Louie
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Decision Aid ◽  
Transoral Robotic Surgery ◽  
Oncologic Outcomes ◽  
Patient Treatment ◽  
Promising Alternative ◽  
Trade Off ◽  
Cure Rates ◽  
Adult Volunteers

Background  Radiotherapy (rt) has been the standard treatment for early oropharyngeal cancer, achieving excellent outcomes, but with significant toxicities. Transoral robotic surgery (tors) has emerged as a promising alternative. A decision aid (da) can help to establish patient treatment preferences.Methods A da was developed and piloted in 40 healthy adult volunteers. Assuming equal oncologic outcomes of the treatments, participants indicated their preference. The treatment trade-off point was then established, and participant perceptions were elicited.Results More than 80% of participants initially selected tors for treatment, regardless of facilitator background. For all participants, the treatment trade-off point changed after an average 15% cure benefit. Treatment toxicities, duration, novelty, and perceptions all influenced treatment selection. All subjects valued the da.Conclusions A da developed for early oropharyngeal cancer treatment holds promise in the era of shared decision making. Assuming equal cure rates, tors was preferred over rt by healthy volunteers.

scholarly journals Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer

2014 ◽  
Vol 272 (7) ◽  
pp. 1551-1552 ◽  
Author(s):  
Gregory S. Weinstein ◽  
Bert W. O’Malley ◽  
Alessandra Rinaldo ◽  
Carl E. Silver ◽  
Jochen A. Werner ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

Current Indications for Transoral Robotic Surgery in Oropharyngeal Cancer

2020 ◽  
Vol 53 (6) ◽  
pp. 949-964
Author(s):  
Harman S. Parhar ◽  
Christina M. Yver ◽  
Robert M. Brody
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Transoral Robotic Surgery

scholarly journals Magnifying Endoscopy with Narrow Band Imaging to Determine the Extent of Resection in Transoral Robotic Surgery of Oropharyngeal Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Ichiro Tateya ◽  
Seiji Ishikawa ◽  
Shuko Morita ◽  
Hiroyuki Ito ◽  
Tatsunori Sakamoto ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Extent Of Resection ◽  
Transoral Robotic Surgery ◽  
Magnifying Endoscopy ◽  
Pharyngeal Cancer ◽  
Invasive Treatment ◽  
High Resolution Images

Transoral robotic surgery (TORS) is a less invasive treatment that is becoming popular all over the world. One of the most important factors for achieving success in TORS is the ability to determine the extent of resection during the procedure as the extent of resection in the laryngopharynx not only affects oncological outcomes but also directly affects swallowing and voice functions. Magnifying endoscopy with narrow band imaging (ME-NBI) is an innovative optical technology that provides high-resolution images and is useful in detecting early superficial pharyngeal cancers, which are difficult to detect by standard endoscopy. A 55-year-old male with superficial oropharyngeal cancer has been successfully treated by combining MB-NBI with TORS and MB-NBI was useful in determining the extent of resection. ME-NBI with TORS will make it possible to achieve a higher ratio of minimally invasive treatment in pharyngeal cancer.

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