Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy

2018 ◽  
Vol 27 (4) ◽  
pp. 643-649 ◽  
Author(s):  
Giancarlo Tirelli ◽  
Francesca Boscolo Nata ◽  
Marco Piovesana ◽  
Eliana Quatela ◽  
Nicoletta Gardenal ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Transoral 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.

Predictors of swallow function after transoral surgery for locally advanced oropharyngeal cancer

2019 ◽  
Vol 130 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Jennifer H. Gross ◽  
Melanie Townsend ◽  
Helena Y. Hong ◽  
Emily Miller ◽  
Dorina Kallogjeri ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Locally Advanced ◽  
Transoral Surgery ◽  
Swallow Function

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.

scholarly journals A case of severe delayed hemorrhage after salvage transoral surgery for recurrent oropharyngeal cancer

Toukeibu Gan ◽  
2020 ◽  
Vol 46 (4) ◽  
pp. 401-405
Author(s):  
Yuki Harada ◽  
Shunsuke Miyamoto ◽  
Yutomo Seino ◽  
Takashi Matsuki ◽  
Koichi Kano ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Transoral Surgery ◽  
Delayed Hemorrhage

scholarly journals Value of transoral surgery for human papillomavirus-mediated oropharyngeal cancer: validation of a new staging system in Japanese patients

2019 ◽  
Vol 47 (10) ◽  
pp. 5048-5059 ◽  
Author(s):  
Eiko Kimura ◽  
Koji Araki ◽  
Masayuki Tomifuji ◽  
Yuya Tanaka ◽  
Kosuke Uno ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Oropharyngeal Cancer ◽  
Poor Prognosis ◽  
Staging System ◽  
Japanese Patients ◽  
Clinical Staging ◽  
Transoral Surgery ◽  
Seventh Edition ◽  
Eighth Edition ◽  
Ajcc Staging

Objective This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV+-OPC) and the effectiveness of transoral surgery. Methods Fifty-three patients with HPV+-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. Results The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV+-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV+-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). Conclusions The eighth edition of the AJCC determines the prognosis of HPV+-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV+-OPC have a poor prognosis, but TOVS might improve the prognosis.

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