Oncologic outcomes of transoral robotic surgery for HPV-negative oropharyngeal carcinomas.
HPV negative
head and neck cancer
oropharyngeal cancer
transoral robotic surgery
transoral surgery
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
08
02
2021
received:
20
09
2020
accepted:
25
05
2021
pubmed:
9
6
2021
medline:
30
9
2021
entrez:
8
6
2021
Statut:
ppublish
Résumé
Patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC) continue to experience disappointing outcomes following chemoradiotherapy (CRT) and appreciable morbidity following historical surgical approaches. We aimed to investigate the oncologic outcomes and perioperative morbidity of a transoral robotic surgery (TORS) approach to surgically resectable HPV-negative OPSCC. Retrospective analysis HPV-negative OPSCC patients who underwent TORS, neck dissection and pathology-guided adjuvant therapy (2005-2017). Fifty-six patients (91.1% stage III/IV) were included. Three-year overall survival, locoregional control, and disease-free survival were 85.5%, 84.4%, and 73.6%, respectively (median follow-up 30.6 months, interquartile range 18.4-66.6). Eighteen (32.1%) patients underwent adjuvant radiotherapy and 20 (39.3%) underwent adjuvant CRT. Perioperative mortality occurred in one (1.8%) patient and hemorrhage occurred in two (3.6%) patients. Long-term gastrostomy and tracheostomy rates were 5.4% and 0.0%, respectively. The TORS approach for resectable HPV-negative OPSCC can achieve encouraging oncologic outcomes with infrequent morbidity.
Sections du résumé
BACKGROUND
Patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC) continue to experience disappointing outcomes following chemoradiotherapy (CRT) and appreciable morbidity following historical surgical approaches. We aimed to investigate the oncologic outcomes and perioperative morbidity of a transoral robotic surgery (TORS) approach to surgically resectable HPV-negative OPSCC.
METHODS
Retrospective analysis HPV-negative OPSCC patients who underwent TORS, neck dissection and pathology-guided adjuvant therapy (2005-2017).
RESULTS
Fifty-six patients (91.1% stage III/IV) were included. Three-year overall survival, locoregional control, and disease-free survival were 85.5%, 84.4%, and 73.6%, respectively (median follow-up 30.6 months, interquartile range 18.4-66.6). Eighteen (32.1%) patients underwent adjuvant radiotherapy and 20 (39.3%) underwent adjuvant CRT. Perioperative mortality occurred in one (1.8%) patient and hemorrhage occurred in two (3.6%) patients. Long-term gastrostomy and tracheostomy rates were 5.4% and 0.0%, respectively.
CONCLUSION
The TORS approach for resectable HPV-negative OPSCC can achieve encouraging oncologic outcomes with infrequent morbidity.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2923-2934Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29(32):4294-4301. https://doi.org/10.1200/JCO.2011.36.4596.
D'Souza G, Kreimer AR, Viscidi R, et al. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007;356(19):1944-1956. https://doi.org/10.1056/NEJMoa065497.
Ryerson AB, Peters ES, Coughlin SS, et al. Burden of potentially human papillomavirus-associated cancers of the oropharynx and oral cavity in the US, 1998-2003. Cancer. 2008;113(10 Suppl):2901-2909. https://doi.org/10.1002/cncr.23745.
Gillison ML. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol. 2004;31(6):744-754. https://doi.org/10.1053/j.seminoncol.2004.09.011.
Chaturvedi AK, Engels EA, Anderson WF, Gillison ML. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26(4):612-619. https://doi.org/10.1200/JCO.2007.14.1713.
Marur S, D'Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol. 2010;11(8):781-789. https://doi.org/10.1016/S1470-2045(10)70017-6.
Hockstein NG, O'Malley BW, Weinstein GS. Assessment of intraoperative safety in transoral robotic surgery. Laryngoscope. 2006;116(2):165-168. https://doi.org/10.1097/01.mlg.0000199899.00479.75.
Cohen MA, Weinstein GS, O'Malley BW, Feldman M, Quon H. Transoral robotic surgery and human papillomavirus status: oncologic results. Head Neck. 2011;33(4):573-580. https://doi.org/10.1002/hed.21500.
Weinstein GS, O'Malley BW, Magnuson JS, et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope. 2012;122(8):1701-1707. https://doi.org/10.1002/lary.23294.
de Almeida JR, Li R, Magnuson JS, et al. Oncologic outcomes after transoral robotic surgery: a multi-institutional study. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1043-1051. https://doi.org/10.1001/jamaoto.2015.1508.
de Almeida JR, Byrd JK, Wu R, et al. A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope. 2014;124(9):2096-2102. https://doi.org/10.1002/lary.24712.
Moore EJ, Olsen SM, Laborde RR, et al. Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc. 2012;87(3):219-225. https://doi.org/10.1016/j.mayocp.2011.10.007.
Cracchiolo JR, Roman BR, Kutler DI, Kuhel WI, Cohen MA. Adoption of transoral robotic surgery compared with other surgical modalities for treatment of oropharyngeal squamous cell carcinoma. J Surg Oncol. 2016;114(4):405-411. https://doi.org/10.1002/jso.24353.
Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24-35. https://doi.org/10.1056/NEJMoa0912217.
Posner MR, Lorch JH, Goloubeva O, et al. Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial. Ann Oncol. 2011;22(5):1071-1077. https://doi.org/10.1093/annonc/mdr006.
Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol. 2014;32(27):2940-2950. https://doi.org/10.1200/JCO.2013.53.5633.
Rischin D, Young RJ, Fisher R, et al. Prognostic significance of p16INK4A and human papillomavirus in patients with oropharyngeal cancer treated on TROG 02.02 phase III trial. J Clin Oncol. 2010;28(27):4142-4148. https://doi.org/10.1200/JCO.2010.29.2904.
Mirghani H, Amen F, Tao Y, Deutsch E, Levy A. Increased radiosensitivity of HPV-positive head and neck cancers: molecular basis and therapeutic perspectives. Cancer Treat Rev. 2015;41(10):844-852. https://doi.org/10.1016/j.ctrv.2015.10.001.
Zhang M, Hong AM. The human papillomavirus confers radiosensitivity in oropharyngeal cancer cells by enhancing DNA double strand break. Oncotarget. 2020;11(16):1417-1426. https://doi.org/10.18632/oncotarget.27535.
Parsons JT, Mendenhall WM, Stringer SP, et al. Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer. 2002;94(11):2967-2980. https://doi.org/10.1002/cncr.10567.
Williams CE, Kinshuck AJ, Derbyshire SG, et al. Transoral laser resection versus lip-split mandibulotomy in the management of oropharyngeal squamous cell carcinoma (OPSCC): a case match study. Eur Arch Otorhinolaryngol. 2014;271(2):367-372. https://doi.org/10.1007/s00405-013-2501-5.
Chen AY, Zhu J, Fedewa S. Temporal trends in oropharyngeal cancer treatment and survival: 1998-2009. Laryngoscope. 2014;124(1):131-138. https://doi.org/10.1002/lary.24296.
Boscolo-Rizzo P, Gava A, Baggio V, et al. Matched survival analysis in patients with locoregionally advanced resectable oropharyngeal carcinoma: platinum-based induction and concurrent chemoradiotherapy versus primary surgical resection. Int J Radiat Oncol Biol Phys. 2011;80(1):154-160. https://doi.org/10.1016/j.ijrobp.2010.01.032.
Zhen W, Karnell LH, Hoffman HT, Funk GF, Buatti JM, Menck HR. The National Cancer Data Base report on squamous cell carcinoma of the base of tongue. Head Neck. 2004;26(8):660-674. https://doi.org/10.1002/hed.20064.
Frank K, Elliott DA, Reddy K, Saraiya S. An NCDB analysis investigating outcomes in HPV negative oropharyngeal carcinoma - an attempt to bridge the gap due to lack of accrual in RTOG 1221. Int J Radiat Oncol. 2018;102(3):e218. https://doi.org/10.1016/j.ijrobp.2018.07.755.
Holsinger FC, Ferris RL. Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and clinical trials. J Clin Oncol. 2015;33(29):3285-3292. https://doi.org/10.1200/JCO.2015.62.3157.
Nichols AC, Theurer J, Prisman E, et al. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol. 2019;20(10):1349-1359. https://doi.org/10.1016/S1470-2045(19)30410-3.
Hinni ML, Zarka MA, Hoxworth JM. Margin mapping in transoral surgery for head and neck cancer. Laryngoscope. 2013;123(5):1190-1198. https://doi.org/10.1002/lary.23900.
Laccourreye O, Hans S, Ménard M, Garcia D, Brasnu D, Holsinger FC. Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence. Arch Otolaryngol Head Neck Surg. 2005;131(7):592-599. https://doi.org/10.1001/archotol.131.7.592.
Holsinger FC, McWhorter AJ, Ménard M, Garcia D, Laccourreye O. Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results. Arch Otolaryngol Head Neck Surg. 2005;131(7):583-591. https://doi.org/10.1001/archotol.131.7.583.
Dabas S, Gupta K, Sharma AK, Shukla H, Ranjan R, Sharma DK. 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(11):2137-2142. https://doi.org/10.1016/j.ejso.2019.06.027.
Bahl A, Kumar P, Dar L, et al. Prevalence and trends of human papillomavirus in oropharyngeal cancer in a predominantly north Indian population. Head Neck. 2014;36(4):505-510. https://doi.org/10.1002/hed.23317.
Park YM, Kim HR, Cho BC, Keum KC, Cho NH, Kim S-H. Transoral robotic surgery-based therapy in patients with stage III-IV oropharyngeal squamous cell carcinoma. Oral Oncol. 2017;75:16-21. https://doi.org/10.1016/j.oraloncology.2017.10.014.
No JH, Sung M-W, Hah JH, et al. Prevalence and prognostic value of human papillomavirus genotypes in tonsillar squamous cell carcinoma: a Korean multicenter study. Cancer. 2015;121(4):535-544. https://doi.org/10.1002/cncr.29086.
Fakhry C, Westra WH, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst. 2008;100(4):261-269. https://doi.org/10.1093/jnci/djn011.
Dziegielewski PT, Mlynarek AM, Dimitry J, Harris JR, Seikaly H. The mandibulotomy: friend or foe? Safety outcomes and literature review. Laryngoscope. 2009;119(12):2369-2375. https://doi.org/10.1002/lary.20694.
Nguyen AT, Luu M, Mallen-St Clair J, et al. Comparison of survival after transoral robotic surgery vs nonrobotic surgery in patients with early-stage oropharyngeal squamous cell carcinoma. JAMA Oncol. 2020;6(10):1555-1562. https://doi.org/10.1001/jamaoncol.2020.3172.
Clark JM, Holmes EM, O'Connell DA, Harris J, Seikaly H, Biron VL. Long-term survival and swallowing outcomes in advanced stage oropharyngeal squamous cell carcinomas. Papillomavirus Res. 2019;7:1-10. https://doi.org/10.1016/j.pvr.2018.09.002.
Seikaly H, Biron VL, Zhang H, et al. Role of primary surgery in the treatment of advanced oropharyngeal cancer: primary surgery for advanced oropharyngeal cancer. Head Neck. 2016;38(S1):E571-E579. https://doi.org/10.1002/hed.24042.
Dale OT, Sood S, Shah KA, et al. Long-term survival outcomes in patients with surgically treated oropharyngeal cancer and defined human papilloma virus status. J Laryngol Otol. 2016;130(11):1048-1053. https://doi.org/10.1017/S0022215116009099.
Duvvuri U, Myers JN. Contemporary management of oropharyngeal cancer. Curr Probl Surg. 2009;46(2):119-184. https://doi.org/10.1067/j.cpsurg.2008.10.003.
Calais G, Alfonsi M, Bardet E, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst. 1999;91(24):2081-2086. https://doi.org/10.1093/jnci/91.24.2081.
Stokes W, Ramadan J, Lawson G, Ferris FRL, Holsinger FC, Turner MT. Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review. Laryngoscope. 2020;131(1):95-105. https://doi.org/10.1002/lary.28580.
Parhar HS, Gausden E, Patel J, et al. Analysis of readmissions after transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck. 2018;40(11):2416-2423. https://doi.org/10.1002/hed.25362.
de Almeida JR, Park RCW, Villanueva NL, Miles BA, Teng MS, Genden EM. Reconstructive algorithm and classification system for transoral oropharyngeal defects. Head Neck. 2014;36(7):934-941. https://doi.org/10.1002/hed.23353.
Hatten KM, Brody RM, Weinstein GS, et al. Defining the role of free flaps for transoral robotic surgery. Ann Plast Surg. 2018;80(1):45-49. https://doi.org/10.1097/SAP.0000000000001263.
de Arruda FF, Puri DR, Zhung J, et al. Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol. 2006;64(2):363-373. https://doi.org/10.1016/j.ijrobp.2005.03.006.
Sharma A, Patel S, Baik FM, et al. Survival and gastrostomy prevalence in patients with oropharyngeal cancer treated with Transoral robotic surgery vs chemoradiotherapy. JAMA Otolaryngol Head Neck Surg. 2016;142(7):691-697. https://doi.org/10.1001/jamaoto.2016.1106.
Lawson JD, Otto K, Chen A, Shin DM, Davis L, Johnstone PAS. Concurrent platinum-based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base. Head Neck. 2008;30(3):327-335. https://doi.org/10.1002/hed.20694.
Shiley S, Hargunani C, Skoner J, Holland J, Wax M. Swallowing function after chemoradiation for advanced stage oropharyngeal cancer. Otolaryngol Head Neck Surg. 2006;134(3):455-459. https://doi.org/10.1016/j.otohns.2005.10.054.
Rusthoven KE, Raben D, Ballonoff A, Kane M, Song JI, Chen C. Effect of radiation techniques in treatment of oropharynx cancer. Laryngoscope. 2008;118(4):635-639. https://doi.org/10.1097/MLG.0b013e31815fdf0e.
Garden AS, Harris J, Trotti A, et al. Long-term results of concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: a phase II trial of the radiation therapy oncology group (RTOG 99-14). Int J Radiat Oncol Biol Phys. 2008;71(5):1351-1355. https://doi.org/10.1016/j.ijrobp.2008.04.006.
McIlwain WR, Sood AJ, Nguyen SA, Day TA. Initial symptoms in patients with HPV-positive and HPV-negative oropharyngeal cancer. JAMA Otolaryngol Neck Surg. 2014;140(5):441-447. https://doi.org/10.1001/jamaoto.2014.141.
Persky MJ, Albergotti WG, Rath TJ, et al. Positive margins by oropharyngeal subsite in transoral robotic surgery for T1/T2 squamous cell carcinoma. Otolaryngol Head Neck Surg. 2018;158(4):660-666. https://doi.org/10.1177/0194599817742852.
Grønhøj C, Kronberg Jakobsen K, Kjaer E, Friborg J, von Buchwald C. Comorbidity in HPV+ and HPV- oropharyngeal cancer patients: a population-based, case-control study. Oral Oncol. 2019;96:1-6. https://doi.org/10.1016/j.oraloncology.2019.06.035.
Joseph AW, Ogawa T, Bishop JA, et al. Molecular etiology of second primary tumors in contralateral tonsils of human papillomavirus-associated index tonsillar carcinomas. Oral Oncol. 2013;49(3):244-248. https://doi.org/10.1016/j.oraloncology.2012.09.009.
Morris LGT, Sikora AG, Patel SG, Hayes RB, Ganly I. Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol. 2011;29(6):739-746. https://doi.org/10.1200/JCO.2010.31.8311.
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710-718. https://doi.org/10.1093/aje/kwk052.