Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation☆
Author links open overlay panelBhaswanthDhanireddyabeNicolas P.BurnettabSreejaSanampudiabCharles E.WootenabJonSlezakbcBrentSheltondLaurenSheltondAndrewShearerdSusanneArnoldaMaheshKudrimotiaThomas J.Gala
a
Department of Radiation Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
b
Markey Cancer Center, University of Kentucky, Lexington, KY, United States of America
c
Department of Otolaryngology, College of Medicine, University of Kentucky, Lexington, KY, United States of America
d
Department of Cancer Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States of America
e
Department of Hematology and Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY, United States of America
Received 1 March 2019, Available online 4 June 2019.

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https://doi.org/10.1016/j.amjoto.2019.06.001Get rights and content
Abstract
Purpose
Optimal treatment strategies for the management of oropharyngeal squamous cell carcinoma (OPSCC) remain unclear. The objective of this study is to examine the role of transoral robotic surgery (TORS) on functional and treatment outcomes.

Materials and methods
A retrospective review of patients with OPSCC (tonsil/base of tongue) who underwent TORS with neck dissection± adjuvant therapy between January 2011 to December 2016 were compared to a stage matched cohort of patients treated with primary chemoradiation. Demographic, treatment, and outcome data were collected.

Results
54 patients received primary chemoradiation and 65 patients (surgical group) received TORS ± adjuvant therapy for clinically staged disease meeting study criteria. 25% (N = 17) were treated with surgery alone. The remainder of the surgical group received postoperative radiation (N = 48), half of which received adjuvant chemotherapy (N = 24) in addition to radiation. 63% (N = 41) of the patients did not have risk factors for chemotherapy. No differences in overall or disease free survival were observed with TORS compared to chemoradiation (p = 0.9), although Charlson Comorbidity Index (CCI) was higher in the surgical group (p = 0.01). The strongest predictor of prolonged gastrostomy tube use was not treatment, but rather co-morbidity (p = 0.03), with no significant differences beyond 12 months.

Conclusion
Although no significant survival differences were observed across treatment groups, this was maintained despite increased comorbidity index in the surgical patients. Given the ability to de-escalate and/or eliminate adjuvant therapy, particularly in a less healthy population, TORS would appear to be the viable treatment option it has become.

Keywords
Oropharyngeal cancerTransoral robotic surgeryChemoradiation and intensity modulated radiation therapyTORSNeck dissection