Avoidance of primary site adjuvant radiotherapy following transoral robotic surgery: a cohort study.
adjuvant radiotherapy
deglutition
oropharyngeal neoplasms
quality of life
robotic surgical procedures
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
20
12
2021
received:
10
10
2021
accepted:
21
12
2021
pubmed:
13
1
2022
medline:
15
4
2022
entrez:
12
1
2022
Statut:
ppublish
Résumé
Post-operative radiotherapy (PORT) volumes and dose to target structures likely influence swallowing function and quality of life following transoral robotic surgery (TORS). The aim of this study is to analyse disease control and swallowing outcomes in patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) to determine the impact of omitting the primary site from the PORT treatment volume. Prospectively collected data from patients that underwent TORS between March 2013 and April 2021 were reviewed. Patients were categorized into three groups: (1) no PORT, (2) PORT to the neck alone or (3) PORT to the primary site and neck. Survival curves were generated according to the Kaplan-Meier method and swallowing was assessed using the Functional Oral Intake Scale, Public Status Scale Head and Neck, MD Anderson Dysphagia Inventory and feeding tube/gastrostomy dependence. A total of 121 patients underwent TORS, of which 103 met inclusion criteria with a median follow up of 2.6 years. No patients developed local recurrence. The 3-year regional control rates were 90%, 100% and 100% for groups 1, 2 and 3, respectively. Disease-specific survival was 97% over the study period. Patients that received PORT to both the primary site and the neck (group 3) had worse swallowing outcomes at 12 months. Following TORS for OPSCC, avoiding PORT to the primary site, in appropriately selected patients, appears to be oncologically safe and is associated with superior swallowing outcomes.
Sections du résumé
BACKGROUND
Post-operative radiotherapy (PORT) volumes and dose to target structures likely influence swallowing function and quality of life following transoral robotic surgery (TORS). The aim of this study is to analyse disease control and swallowing outcomes in patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) to determine the impact of omitting the primary site from the PORT treatment volume.
METHODS
Prospectively collected data from patients that underwent TORS between March 2013 and April 2021 were reviewed. Patients were categorized into three groups: (1) no PORT, (2) PORT to the neck alone or (3) PORT to the primary site and neck. Survival curves were generated according to the Kaplan-Meier method and swallowing was assessed using the Functional Oral Intake Scale, Public Status Scale Head and Neck, MD Anderson Dysphagia Inventory and feeding tube/gastrostomy dependence.
RESULTS
A total of 121 patients underwent TORS, of which 103 met inclusion criteria with a median follow up of 2.6 years. No patients developed local recurrence. The 3-year regional control rates were 90%, 100% and 100% for groups 1, 2 and 3, respectively. Disease-specific survival was 97% over the study period. Patients that received PORT to both the primary site and the neck (group 3) had worse swallowing outcomes at 12 months.
CONCLUSION
Following TORS for OPSCC, avoiding PORT to the primary site, in appropriately selected patients, appears to be oncologically safe and is associated with superior swallowing outcomes.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
511-517Informations de copyright
© 2022 Royal Australasian College of Surgeons.
Références
Schmitt NC, Duvvuri U. Transoral robotic surgery for oropharyngeal squamous cell carcinoma. Curr. Opin. Otolaryngol. Head Neck Surg. 2015; 23: 127-31.
Siddiqui F, Movsas B. Management of radiation toxicity in head and neck cancers. Semin. Radiat. Oncol. 2017; 27: 340-9.
Swisher-McClure S, Lukens JN, Aggarwal C et al. A phase 2 trial of alternative volumes of oropharyngeal irradiation for de-intensification (AVOID): omission of the resected primary tumor bed after Transoral robotic surgery for human papilloma virus-related squamous cell carcinoma of the oropharynx. Int. J. Radiat. Oncol. 2020; 106: 725-32.
Grégoire V, Evans M, Le Q-T et al. Delineation of the primary tumour clinical target volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG oncology, PHNS, SBRT, SOMERA, SRO, SSHNO TROG consensus guidelines. Radiother. Oncol. 2018; 126: 3-24.
Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional Oral intake scale for dysphagia in stroke patients. Arch. Phys. Med. Rehabil. 2005; 86: 1516-20.
List MA, Ritter-Sterr C, Lansky SB. A performance status scale for head and neck cancer patients. Cancer 1990; 66: 6-569.
Chen AY, Frankowski R, Bishop-Leone J et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch. Otolaryngol. Head Neck Surg. 2001; 127: 1385-9.
Adelstein DJ, Ismaila N, Ku JA et al. Role of treatment Deintensification in the management of p16+ oropharyngeal cancer: ASCO provisional clinical opinion. J. Clin. Oncol. 2019; 37: 1578-89.
Charters EK, Bogaardt H, Freeman-Sanderson AL, Ballard KJ. Systematic review and meta-analysis of the impact of dosimetry to dysphagia and aspiration related structures. Head Neck 2019; 41: 1984-98.
de Almeida JR, Li R, Magnuson JS et al. Oncologic outcomes after Transoral robotic surgery: a multi-institutional study. JAMA Otolaryngol. Neck Surg. 2015; 141: 1043-51.
Weinstein GS, Quon H, Newman J et al. Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch. Otolaryngol. Head Neck Surg. 2012; 138: 7.
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: 1349-59.
Charters E, Wu R, Milross C et al. Swallowing and communication outcomes following primary transoral robotic surgery. Head Neck 2021; 43: 2013-23.
Hutcheson KA, Warneke CL, Yao CMKL et al. Dysphagia after primary transoral robotic surgery with neck dissection vs nonsurgical therapy in patients with low- to intermediate-risk oropharyngeal cancer. JAMA Otolaryngol. Neck Surg. 2019; 145: 1053-63.