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Ebisumoto K, Sakai A, Iijima H, Goto F, Yamauchi M, Maki D, Teramura T, Wasano K, Okami K. Swallowing Function and Quality of Life in Patients Treated With Transoral Videolaryngoscopic Surgery for Pharyngolaryngeal Cancer. Cureus 2024; 16:e57143. [PMID: 38686230 PMCID: PMC11057633 DOI: 10.7759/cureus.57143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND It is controversial whether transoral resection for early pharyngolaryngeal cancer preserves swallowing function and quality of life. We investigated swallowing function and quality of life before and after transoral videolaryngoscopic surgery (TOVS). METHODS Seventy-three patients with pharyngolaryngeal cancer who underwent TOVS between July 2012 and July 2022 were enrolled in this prospective analysis. The Hyodo score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires were recorded preoperatively and at three, six, and 12 months postoperatively, in addition to the postoperative functional outcome swallowing scale (FOSS) at six months postoperatively. RESULTS Although most patients could consume food orally without restrictions with a preferable FOSS score, 23 patients showed impaired Hyodo scores. Age ≥65 years significantly predicted impaired swallowing. Sub-scores of the impaired patient group showed worsening for the glottal closure reflex when the endoscope touched the epiglottis or arytenoid, as well as a reduction in the extent of pharyngeal clearance following the ingestion of blue-dyed water. CONCLUSION After TOVS, swallowing function is generally well preserved. Elderly patients, especially those with laryngeal hypoesthesia and poor clearance, are at risk of swallowing dysfunction.
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Affiliation(s)
- Koji Ebisumoto
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Akihiro Sakai
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Hiroaki Iijima
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Fumiyuki Goto
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Mayu Yamauchi
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Daisuke Maki
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Takanobu Teramura
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Koichiro Wasano
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Kenji Okami
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
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Silver JA, Bouganim N, Richardson K, Henry M, Mascarella MA, Ramirez-GarciaLuna J, Golabi N, Mlynarek AM, Zeitouni A, Hier MP, Caglar D, Esfahani K, Sadeghi N. Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:65-74. [PMID: 38060238 PMCID: PMC10704343 DOI: 10.1001/jamaoto.2023.3781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023]
Abstract
Importance Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. Objective To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. Design, Settings, and Participants This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. Outcome Measures QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. Results Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, -4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, -1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. Conclusion and Relevance The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.
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Affiliation(s)
- Jennifer A. Silver
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melissa Henry
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A. Mascarella
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Nahid Golabi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael P. Hier
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Derin Caglar
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
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Strüder D, Ebert J, Kalle F, Schraven SP, Eichhorst L, Mlynski R, Großmann W. Head and Neck Cancer: A Study on the Complex Relationship between QoL and Swallowing Function. Curr Oncol 2023; 30:10336-10350. [PMID: 38132387 PMCID: PMC10742452 DOI: 10.3390/curroncol30120753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is linked to significant morbidity, adversely affecting survival and functional capacity. Post-treatment challenges such as pain, dysphonia, and dysphagia are common, prompting increased attention in survivorship research. Quality of Life (QoL) questionnaires, especially the MD Anderson Dysphagia Inventory (MDADI), are prevalent outcome measures in clinical studies but often lack parallel objective swallowing function evaluations, leading to potential outcome discrepancies. This study aimed to illuminate the relationship between subjective QoL (EQ-5D-5L and MDADI) measures and objective swallowing function (evaluated via Fiberoptic Endoscopic Evaluation of Swallowing, FEES) in patients with HNSCC. The analysis revealed a notable discordance between objective measures of swallowing function, such as the Penetration-Aspiration Scale (PAS) and residue ratings in the vallecula or piriform sinus, and patients' subjective QoL assessments (p = 0.21). Despite the lack of correlation, swallowing-related QoL, as measured by the MDADI, was more indicative of disease severity than generic QoL assessments. Generic QoL scores did not demonstrate substantial variation between patients. In contrast, MDADI scores significantly declined with advancing tumor stage, multimodal therapy, and reliance on feeding tubes. However, the clinical significance of this finding was tempered by the less than 10-point difference in MDADI scores. The findings of this study underline the limitations of QoL measures as standalone assessments in patients with HNSCC, given their reliance on patient-perceived impairment. While subjective QoL is a crucial aspect of evaluating therapeutic success and patient-centric outcomes, it may fail to capture critical clinical details such as silent aspirations. Consequently, QoL assessments should be augmented by objective evaluations of swallowing function in clinical research and practice to ensure a holistic understanding of patient well-being and treatment impact.
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Affiliation(s)
- Daniel Strüder
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
| | - Johanna Ebert
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
| | - Friederike Kalle
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
| | - Sebastian P. Schraven
- Department of Otorhinolaryngology, Head and Neck Surgery, RWTH Aachen University Hospital, D-52074 Aachen, Germany;
| | - Lennart Eichhorst
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
| | - Robert Mlynski
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
| | - Wilma Großmann
- Department of Otorhinolaryngology, Head and Neck Surgery “Otto Körner”, Rostock University Medical Center, D-18057 Rostock, Germany; (J.E.); (F.K.); (L.E.); (R.M.); (W.G.)
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Blom M, Zhang H, Tescher A, Dixon B, Magarey M. Staged neck dissection prior to transoral robotic surgery for oropharyngeal cancer: does it reduce post-operative complication rates? A multi-centre study of 104 patients. Eur Arch Otorhinolaryngol 2023; 280:5067-5072. [PMID: 37561189 DOI: 10.1007/s00405-023-08108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Transoral robotic surgery (TORS) has become increasingly recognised as a safe and effective treatment for early oropharyngeal squamous cell carcinoma, often performed in conjunction with neck dissection (ND) and vessel ligation. It has been proposed that performing the neck dissection in a staged fashion prior to TORS results in low rates of transoral haemorrhage and pharyngocutaneous fistula, and may aid in TORS patient selection by eliminating patients who would require multi-modality treatment based on nodal pathology. This study aims to assess the effect of staged neck dissection with TORS in mitigating pharyngocutaneous fistulae and post-operative haemorrhage as well as the impact of staged ND on TORS patient selection. METHODS A retrospective cohort analysis was performed of patients undergoing staged ND with intent to proceed to TORS at two Australian hospitals between 2014 and 2022. Incidence of post-operative haemorrhage and pharyngocutaneous fistula and length of inpatient stay was identified. The number of patients who did not proceed to TORS was recorded. RESULTS One hundred and four patients were identified who underwent staged neck dissection with an intention to proceed to TORS. Six patients did not proceed to TORS following pathological assessment of the neck dissection specimen and ninety-eight patients (91 primary, 7 salvage) underwent TORS. There were six cases of secondary haemorrhage (one major, two intermediate and three minor). There were no cases of pharyngocutaneous fistula. CONCLUSION Staged neck dissection prior to TORS results in low rates of haemorrhage and pharyngocutaneous fistula and can improve TORS patient selection.
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Affiliation(s)
- Megan Blom
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
| | - Henry Zhang
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Bart's Health NHS Trust, London, United Kingdom
| | - Anne Tescher
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia
| | - Benjamin Dixon
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Magarey
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia
- Department of Medical Education, University of Melbourne, Melbourne, VIC, Australia
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Larsen MHH, Kehlet H, von Buchwald C. Transoral robotic surgery - time for consensus on pain assessment. A review. Acta Otolaryngol 2023; 143:902-911. [PMID: 37991140 DOI: 10.1080/00016489.2023.2282149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND In Head and Neck surgery Transoral Robotic Surgery (TORS) is evolving as a key treatment option for benign and malignant lesions in the oropharynx. Even so, postoperative pain is one of the primary early complaints following TORS. Well established evidence-based procedure specific pain treatment guidelines are available for a variety of other surgical specialties. However, there are no guidelines for TORS. AIM This review describes the available data of early pain intensity following TORS during rest and procedure related activity. METHODS Literature concerning pain in the immediate postoperative phase following TORS were obtained from two literature databases. RESULTS Most data on pain intensity following TORS are based upon a numeric rating scale, e.g. the Visual Analogue Scale and/or analgesic demands. Only one randomized clinical trial is available reflecting that the literature is mainly based on retrospective and a few prospective studies. Only one study analyzed pain during relevant functionality, i.e. swallowing. Overall, the studies suffer from a non-standardized approach and there is a need for transparent information concerning the timing of pain ratings and methodology. CONCLUSIONS The evidence for optimal pain control is limited, particularly during surgical relevant activity. Postoperative pain rating during activity is a fundamental element in pain trials in order to enhance recovery thereby calling for future consensus on assessment methodology.
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Affiliation(s)
- Mikkel Hjordt Holm Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Dohopolski MJ, Diao K, Hutcheson KA, Akhave NS, Goepfert RP, He W, Lei XJ, Peterson SK, Shen Y, Sumer BD, Smith BD, Sher DJ. Long-term Patient-Reported Outcomes in a Population-Based Cohort Following Radiotherapy vs Surgery for Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:697-707. [PMID: 37382943 PMCID: PMC10311423 DOI: 10.1001/jamaoto.2023.1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Importance Oncologic outcomes are similar for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery or radiotherapy. However, comparative differences in long-term patient-reported outcomes (PROs) between modalities are less well established. Objective To determine the association between primary surgery or radiotherapy and long-term PROs. Design, Setting, and Participants This cross-sectional study used the Texas Cancer Registry to identify survivors of OPSCC treated definitively with primary radiotherapy or surgery between January 1, 2006, and December 31, 2016. Patients were surveyed in October 2020 and April 2021. Exposures Primary radiotherapy and surgery for OPSCC. Main Outcomes and Measures Patients completed a questionnaire that included demographic and treatment information, the MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) module, the Neck Dissection Impairment Index (NDII), and the Effectiveness of Auditory Rehabilitation (EAR) scale. Multivariable linear regression models were performed to evaluate the association of treatment (surgery vs radiotherapy) with PROs while controlling for additional variables. Results Questionnaires were mailed to 1600 survivors of OPSCC identified from the Texas Cancer Registry, with 400 responding (25% response rate), of whom 183 (46.2%) were 8 to 15 years from their initial diagnosis. The final analysis included 396 patients (aged ≤57 years, 190 [48.0%]; aged >57 years, 206 [52.0%]; female, 72 [18.2%]; male, 324 [81.8%]). After multivariable adjustment, no significant differences were found between surgery and radiotherapy outcomes as measured by the MDASI-HN (β, -0.1; 95% CI, -0.7 to 0.6), NDII (β, -1.7; 95% CI, -6.7 to 3.4), and EAR (β, -0.9; 95% CI -7.7 to 5.8). In contrast, less education, lower household income, and feeding tube use were associated with significantly worse MDASI-HN, NDII, and EAR scores, while concurrent chemotherapy with radiotherapy was associated with worse MDASI-HN and EAR scores. Conclusions and Relevance This population-based cohort study found no associations between long-term PROs and primary radiotherapy or surgery for OPSCC. Lower socioeconomic status, feeding tube use, and concurrent chemotherapy were associated with worse long-term PROs. Further efforts should focus on the mechanism, prevention, and rehabilitation of these long-term treatment toxicities. The long-term outcomes of concurrent chemotherapy should be validated and may inform treatment decision making.
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Affiliation(s)
- Michael J. Dohopolski
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Diao
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Neil S. Akhave
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Ryan P. Goepfert
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Weiguo He
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Jennifer Lei
- Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas
| | - Susan K. Peterson
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Baran D. Sumer
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - David J. Sher
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
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30-day morbidity and mortality after transoral robotic surgery for human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma: A retrospective analysis of two prospective adjuvant de-escalation trials (MC1273 & MC1675). Oral Oncol 2023; 137:106248. [PMID: 36603364 DOI: 10.1016/j.oraloncology.2022.106248] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dose de-escalation of adjuvant therapy (DART) in patients with HPV(+)OPSCC was investigated in two prospective Phase II and III clinical trials (MC1273 and MC1675). We report the 30-day morbidity and mortality associated with primary TORS resection in patients enrolled in these trials. MATERIALS AND METHODS Patients with HPV(+)OPSCC, who underwent TORS resection between 2013 and 2020 were considered in this analysis. The severity of postoperative transoral bleeding was graded using both the Hinni Grade (HG) transoral surgery bleeding scale and the Common Terminology for Adverse Events (CTCAE) v5.0. Post-surgical complications within 30 days of surgery, as well as rates of tracheostomy, PEG and nasogastric tube placement. RESULTS 219 patients were included. A total of 7 (3.2 %) patients had a tracheostomy placed at the time of surgery, and all were decannulated within 26 days (median: 5, range: 2-26). There were 33 (15.1 %) returns to the emergency department (ED) with 10 (4.6 %) patients requiring readmission. Using the HG scale, 10 (4.6 %) patients experienced ≥ Grade 3 bleeding with no Grade 5 or 6 bleeds. In contrast, using the CTCAE scale, 15 patients (6.8 %) experienced ≥ Grade 3 bleeding with no Grade 5 bleeds. There was one post-operative death in a patient withdrawn from the trial, and no deaths related to hemorrhage. CONCLUSION AND RELEVANCE TORS for HPV(+)OPSCC in carefully selected patients at a high volume center was associated with low morbidity and mortality.
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Tapia M, Manji J, Dhillon K, Kleid S, Flatman S, Prasad J, Cardin A, Fua T, Rischin D, Dixon B, J.R Magarey M. The negative predictive value of FDG PET/CT staging in early oropharyngeal squamous cell carcinoma and implications to transoral robotic surgery patient selection. Oral Oncol 2022; 135:106213. [DOI: 10.1016/j.oraloncology.2022.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/12/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022]
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Silver JA, Turkdogan S, Roy CF, Subramaniam T, Henry M, Sadeghi N. De-Escalation Strategies for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma—Where Are We Now? Curr Oncol 2022; 29:3668-3697. [PMID: 35621685 PMCID: PMC9139371 DOI: 10.3390/curroncol29050295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 12/22/2022] Open
Abstract
The prevalence of oropharyngeal squamous cell carcinoma has been increasing in North America due to human papillomavirus-associated disease. It is molecularly distinct and differs from other head and neck cancers due to the young population and high survival rate. The treatment regimens currently in place cause significant long-term toxicities. Studies have transitioned from mortality-based outcomes to patient-reported outcomes assessing quality of life. There are many completed and ongoing trials investigating alternative therapy regimens or de-escalation strategies to minimize the negative secondary effects while maintaining overall survival and disease-free survival. The goal of this review is to discuss the most recent advancements within the field while summarizing and reviewing the available evidence.
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Affiliation(s)
- Jennifer A. Silver
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Sena Turkdogan
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Catherine F. Roy
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Thavakumar Subramaniam
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Melissa Henry
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3JI, Canada
- Lady-Davis Institute for Medical Research, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Nader Sadeghi
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
- Research Institute of McGill University Health Center, McGill University, Montreal, QC H4A 3JI, Canada
- Correspondence: ; Tel.: +1-514-934-1934 (ext. 34974); Fax: +1-514-843-1403
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Houser TK, Patel T, Tajudeen BA, Bhayani M, Stenson K, Al-Khudari S. Effect of histopathological grade on treatment and survival in base of tongue adenocarcinoma. Am J Otolaryngol 2022; 43:103265. [PMID: 35279531 DOI: 10.1016/j.amjoto.2021.103265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate survival differences between low-grade and high-grade base of tongue (BOT) adenocarcinoma by examining demographics, tumor characteristics, and treatment modalities. METHODS The National Cancer Database was queried for patients with BOT adenocarcinoma between 2004 and 2017. Univariate and multivariate analyses were performed for all cases of BOT adenocarcinoma. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) BOT adenocarcinoma. RESULTS A total of 286 patients with BOT adenocarcinoma were included in the main cohort and divided into low grade (n = 137) and high grade (n = 66). The 5-year overall survival for all patients, low-grade, and high-grade was 67%, 85%, and 58%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), non-white race (HR: 1.79; 95% CI: 1.04-3.25), public insurance (HR: 1.79; 95% CI: 1.02-3.14) and high-grade 3,4 (HR: 2.63; 95% CI: 1.51-4.56). The prognostic factor associated with increased survival for the main cohort was surgery (HR: 0.59; 95% CI: 0.36-0.96). Radiotherapy was associated with improved overall survival for high-grade BOT adenocarcinoma (HR: 0.09; 95% CI: 0.02-0.49) but not for low-grade BOT adenocarcinoma (HR: 0.93; 95% CI: 0.38-2.32). CONCLUSIONS This investigation is the largest to date analyzing the association of treatment modalities with overall survival in BOT adenocarcinoma. Surgery remains standard of treatment, particularly in low-grade cases, with radiotherapy offering additional survival benefit for high-grade BOT adenocarcinoma.
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Affiliation(s)
- Thomas K Houser
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Tirth Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA
| | - Kerstin Stenson
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA.
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11
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Hussain T. Patient Benefit and Quality of Life after Robot-Assisted Head and Neck Surgery. Laryngorhinootologie 2022; 101:S160-S185. [PMID: 35605618 DOI: 10.1055/a-1647-8650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Robotic systems for head and neck surgery are at different stages of technical development and clinical application. Currently, robotic systems are predominantly used for transoral surgery of the pharynx and larynx. Robotic surgery of the neck, the thyroid, and the middle and inner ear is much less common; however, some oncological and functional outcomes have been reported. This article provides an overview of the current state of robot-assisted head and neck surgery with a special emphasis on patient benefit and postoperative quality of life (QoL). The focus is placed on the role of transoral robotic surgery (TORS) for the resection of oropharyngeal carcinomas. For this application, reported long-term outcomes show functional post-operative advantages for selected oropharyngeal cancer patients after TORS compared to open surgery and primary radiotherapy. Since TORS also plays a significant role in the context of potential therapy de-escalation for HPV-positive oropharyngeal cancer patients, ongoing trials are presented. Regarding the evaluation of the therapeutic benefit and the QoL of cancer patients, special attention has to be paid to the large degree of variability of individual patients' preferences. Influencing factors and tools for a detailed assessment of QoL parameters are therefore detailed at the beginning of this article. Notably, while some robotic systems for ear and skull base surgery are being developed in Europe, TORS systems are mainly used in North America and Asia. In Europe and Germany in particular, transoral laser microsurgery (TLM) is a well-established technology for transoral tumor resection. Future trials comparing TORS and TLM with detailed investigation of QoL parameters are therefore warranted and might contribute to identifying suitable fields for the application of the different techniques.
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Affiliation(s)
- Timon Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
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12
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Lee E, Crowder HR, Gorelik D, Badger C, Schottler J, Li NW, Siegel R, Sadeghi N, Thakkar PG, Joshi AS, Goodman JF. Comparison of quality of life outcomes in a de-intensification treatment regimen for p16 + oropharyngeal cancer. Eur Arch Otorhinolaryngol 2022; 279:4533-4540. [DOI: 10.1007/s00405-022-07387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
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13
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Stephen SE, Murphy JM, Beyer FR, Sellstrom D, Paleri V, Patterson JM. Early postoperative functional outcomes following transoral surgery for oropharyngeal cancer: A systematic review. Head Neck 2021; 44:530-547. [PMID: 34882886 DOI: 10.1002/hed.26938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
There has been increased interest in the use of transoral surgery (TOS) for the treatment of oropharyngeal cancer (OPC). This systematic review summarizes the available evidence for validated functional outcomes following TOS for OPC, within the early postoperative period. Key databases were searched. Primary TOS resections of human subjects were included. Validated functional outcomes extracted included instrumental assessment, clinician rated, and patient reported measures. Database searches yielded 7186 titles between 1990 and December 2020. Full-text articles were obtained for 296 eligible studies, which were screened and a resulting 14 studies, comprising 665 participants were included in the review. Oropharyngeal dysfunction following TOS was observed across all three categories of outcome measures (OMs) reported and was dependent on pretreatment function, T-classification, and tumor volume. Future investigations should include optimal OMs to be used in the postoperative setting to allow for conclusive comparisons.
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Affiliation(s)
- Sarah E Stephen
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jennifer M Murphy
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Diane Sellstrom
- Speech, Voice and Swallow Department, Freeman Hospital, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Joanne M Patterson
- School of Health Sciences, Liverpool Head and Neck Cancer Centre, University of Liverpool, Liverpool, UK
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14
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Holcomb AJ, Richmon JD. Surgical margins in a single-modality transoral robotic surgery: A conundrum-Reply. Head Neck 2021; 43:3219-3221. [PMID: 34351028 DOI: 10.1002/hed.26831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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15
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Winkler C, Strobl A, Schmal TJ, Hartl M, Burian M, Formanek M. [Role of Robotic Surgery in ENT]. Wien Med Wochenschr 2021; 172:20-30. [PMID: 34338906 DOI: 10.1007/s10354-021-00865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Abstract
Since the beginning of the 21st century, surgical robots have been used in the ENT-environment. They primarily support surgeons in minimal invasive transoral operations, especially in multidisciplinary treatment concepts of head and neck tumors, but also in snoring surgery the robot provides a complement to the established transoral laser surgery. In the meantime there is a large number of data that deals with the importance of oncological results, function maintenance, economics and future perspectives.Operation areas of the current robot devices are still limited in the ENT-environment. As the number of cases are small, efforts are being made to connect centres on a national and international level. Thus, uniform training standards, targeted knowledge and data exchange as well as further development of systems would be managed better. The creation of small and agile ENT-specific equipment could expand the possibilities as a next step for the future and finally lead to a wide scale of ENT-surgical applications.
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Affiliation(s)
- Christoph Winkler
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich. .,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich.
| | - Andreas Strobl
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich.
| | - Thomas J Schmal
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich.,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich
| | - Maximilian Hartl
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich
| | - Martin Burian
- Abteilung für HNO, Kopf- und Halschirurgie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Österreich
| | - Michael Formanek
- Abteilung für HNO und Phoniatrie, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott-Platz 1, 1020, Wien, Österreich.,Fakultät für Medizin, Sigmund Freud Privat Universität Wien, Campus Prater, Freudplatz 1, 1020, Wien, Österreich
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16
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Holcomb AJ, Herberg M, Strohl M, Ochoa E, Feng AL, Abt NB, Mokhtari TE, Suresh K, McHugh CI, Parikh AS, Sadow P, Faquin W, Faden D, Deschler DG, Varvares MA, Lin DT, Fakhry C, Ryan WR, Richmon JD. Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:2434-2444. [PMID: 33856083 DOI: 10.1002/hed.26708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. METHODS Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method. RESULTS Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. CONCLUSIONS Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
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Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Edgar Ochoa
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tara E Mokhtari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher I McHugh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Sadow
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Faquin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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17
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Abstract
Transoral robotic surgery (TORS) is a rapidly growing diagnostic and therapeutic modality in otolaryngology-head and neck surgery, having already made a large impact in the short time since its inception. Cost-effectiveness analysis is complex, and a thorough cost-effectiveness inquiry should analyze not only financial consequences but also impact on the health state of the patient. The cost-effectiveness of TORS is still under scrutiny, but the early data suggest that TORS is a cost-effective method compared with other available options when used in appropriately selected patients.
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Affiliation(s)
- James Kenneth Byrd
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA.
| | - Rebecca Paquin
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA
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18
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Yao CMKL, Hutcheson KA. Quality of Life Implications After Transoral Robotic Surgery for Oropharyngeal Cancers. Otolaryngol Clin North Am 2020; 53:1117-1129. [PMID: 32917421 DOI: 10.1016/j.otc.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Oropharyngeal cancers and their treatment can exquisitely affect a patient's quality of life and functional outcome. Transoral robotic surgery offers a minimally invasive surgical approach that mitigates injury from traditional open surgical approaches and offers a treatment more likely to have short-term side effects compared with nonsurgical treatment. Feeding tube dependence, oral intake, and swallowing questionnaires, in addition to swallowing evaluations provide a snapshot of a patient's current swallowing function. Investigation of patient-reported quality-of-life outcomes allows for understanding of their symptomatology and the comparison of different treatment strategies.
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Affiliation(s)
- Christopher M K L Yao
- Advanced Head and Neck Surgical Oncology and Microvascular Reconstruction, Department of Head and Neck Surgery, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA; Division of Radiation Oncology, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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19
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Bates JE, Hitchcock KE, Mendenhall WM, Dziegielewski PT, Amdur RJ. Comparing national practice versus standard guidelines for the use of adjuvant treatment following robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck 2020; 42:2602-2606. [DOI: 10.1002/hed.26311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- James E. Bates
- Department of Radiation Oncology University of Florida, College of Medicine Gainesville Florida USA
| | - Kathryn E. Hitchcock
- Department of Radiation Oncology University of Florida, College of Medicine Gainesville Florida USA
| | - William M. Mendenhall
- Department of Radiation Oncology University of Florida, College of Medicine Gainesville Florida USA
| | - Peter T. Dziegielewski
- Department of Otolaryngology University of Florida, College of Medicine Gainesville Florida USA
| | - Robert J. Amdur
- Department of Radiation Oncology University of Florida, College of Medicine Gainesville Florida USA
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20
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Bollig CA, Gilley DR, Ahmad J, Jorgensen JB. Prophylactic arterial ligation following transoral robotic surgery: A systematic review and meta‐analysis. Head Neck 2020; 42:739-746. [DOI: 10.1002/hed.26020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/27/2019] [Accepted: 11/06/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology—Head and Neck SurgeryWashington University School of Medicine St. Louis Missouri
| | - David R. Gilley
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
| | - Jumah Ahmad
- University of Missouri School of Medicine Columbia Missouri
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology—HNS and Communicative DisordersUniversity of Louisville School of Medicine Louisville Kentucky
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21
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Casarin J, Song C, Multinu F, Cappuccio S, Liu E, Butler KA, Glaser GE, Cliby WA, Langstraat CL, Ghezzi F, Fu AZ, Mariani A. Implementing robotic surgery for uterine cancer in the United States: Better outcomes without increased costs. Gynecol Oncol 2020; 156:451-458. [DOI: 10.1016/j.ygyno.2019.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022]
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22
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Gorphe P, Simon C. A systematic review and meta-analysis of margins in transoral surgery for oropharyngeal carcinoma. Oral Oncol 2019; 98:69-77. [DOI: 10.1016/j.oraloncology.2019.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/03/2023]
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23
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Han M, Stanford‐Moore GB, Larson AR, Schoppy DW, Cognetti DM, Joshi AS, Houlton JJ, Ryan WR. Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone. Laryngoscope 2019; 130:E423-E435. [DOI: 10.1002/lary.28344] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/13/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mary Han
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
- School of MedicineUniversity of California‐San Francisco San Francisco California
| | - Gaelen B. Stanford‐Moore
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - Andrew R. Larson
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David W. Schoppy
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David M. Cognetti
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania
| | - Arjun S. Joshi
- Division of Head and Neck Oncologic Surgery, Department of SurgeryGeorge Washington University Washington DC
| | - Jeffery J. Houlton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of Washington Seattle Washington U.S.A
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
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24
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Kraimer K, Ganti A, Plitt MA, Revenaugh P, Stenson K, Tajudeen BA, Al-Khudari S. Prognostic Indicators in Base of Tongue Adenocarcinoma: A Population-Based Analysis. EAR, NOSE & THROAT JOURNAL 2019; 100:467S-471S. [PMID: 31619077 DOI: 10.1177/0145561319881241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The objectives of this investigation are to characterize the epidemiology of base of tongue adenocarcinoma utilizing a population-based database and to identify prognostic factors that may affect survival. METHODS A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results database. Univariate Kaplan-Meier analysis and multivariate Cox-regression analysis were performed to evaluate the association of suspected prognostic factors with survival. Overall survival (OS) and disease-specific survival (DSS) were the primary outcome measures. RESULTS A total of 176 cases were eligible based on inclusion criteria. The 5-year OS and DSS were 49% and 66%, respectively. On multivariate analysis, surgical management was associated with improved OS and DSS (OS hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.20-0.58, P < .001; DSS HR: 0.20, 95% CI: 0.09-0.48, P < .001), while higher tumor grade was associated with worse OS and DSS (OS HR: 1.58, 95% CI: 1.14-2.19, P = .006; DSS HR: 1.68, 95% CI: 1.01-2.79, P = .045). Administration of chemotherapy or radiation did not have a significant association with OS or DSS. CONCLUSION This investigation is the largest to date to analyze the base of tongue adenocarcinoma as its own entity. Surgery remains the mainstay of treatment, and lower tumor grade is associated with improved survival in these patients. Administration of radiation or chemotherapy was not associated with improved survival.
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Affiliation(s)
- Kristen Kraimer
- Rush Medical College, 2461Rush University Medical Center, Chicago, IL, USA
| | - Ashwin Ganti
- Rush Medical College, 2461Rush University Medical Center, Chicago, IL, USA
| | - Max A Plitt
- Department of Otorhinolaryngology, 2461Rush University Medical Center, Chicago, IL, USA
| | - Peter Revenaugh
- Department of Otorhinolaryngology, 2461Rush University Medical Center, Chicago, IL, USA
| | - Kerstin Stenson
- Department of Otorhinolaryngology, 2461Rush University Medical Center, Chicago, IL, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology, 2461Rush University Medical Center, Chicago, IL, USA
| | - Samer Al-Khudari
- Department of Otorhinolaryngology, 2461Rush University Medical Center, Chicago, IL, USA
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25
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Stepp WH, Farquhar D, Sheth S, Mazul A, Mamdani M, Hackman TG, Hayes DN, Zevallos JP. RNA Oncoimmune Phenotyping of HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas by Nodal Status. JAMA Otolaryngol Head Neck Surg 2019; 144:967-975. [PMID: 29710215 DOI: 10.1001/jamaoto.2018.0602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Clinical trials that deintensify treatment for patients with suspected human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) use p16 expression to identify HPV-mediated tumors and guide treatment. While p16 staining has a strong correlation with good outcomes, approximately 12% of p16-positive patients have recurrent disease. Biomarkers that reveal tumor-specific characteristics, such as nodal involvement, may change therapy decisions. Objective To assess whether if a tumor-specific genetic signature exists for node-negative vs node-positive HPV 16-positive/p16-positive OPSCCs. Design, Setting, and Participants This was a retrospective cohort study with randomized case selection for p16 OPSCCs undertaken at a university-based, tertiary care cancer center. Samples were collected from patients with p16-positive OPSCC. A total of 21 HPV 16/p16-positive tumors were used in this study. Main Outcomes and Measures Gene expression profiles of node-negative vs node-positive tumor samples were evaluated using a differential expression analysis approach and the sensitivity and specificity of a molecular signature was determined. Results Among the 21 patients in the study (3 women, 18 men; mean [SD] age, 54.6 [9.6] years), 6 had node-negative disease and 15 had node-positive disease. Using differential expression analysis, we found 146 genes that were significantly different in patients with node-negative disease vs those with node-positive disease, of which 15 genes were used to create a genetic signature that could distinguish node-negative-like from node-positive-like disease. The resultant molecular signature has a sensitivity of 88.2% (95% CI, 63.6%-98.5%) and specificity of 85.7% (95% CI, 42.1%-99.6%). The positive likelihood ratio of this signature was 6.1 (95% CI, 1.0-38.2) and the negative likelihood ratio was 0.1 (95% CI, 0.04-0.5). Given this population's prevalence of node-positive disease of 70.8%, the positive- and negative-predicative values for this gene signature were 93.7% (95% CI, 70.8%-98.9%) and 75.0% (95% CI, 44.1%-92.0%), respectively. In addition, we developed a gene signature using agnostic, machine learning software that identified a 40-gene profile that predicts node-negative disease from node-positive disease (area under the curve, 0.93; 95% CI, 0.63-1.00). Conclusions and Relevance Many HPV-16 and p16-positive tumors are treated as "lower-risk," but they do not have similar genetic compositions at the biological level. The identification of subgroups with unique expression patterns, such as those with nodal metastases, may guide physicians toward alternative or more aggressive therapies. In our study, unguided clustering suggested that that the larger biological characteristics of a tumor could be a better prognostic biomarker.
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Affiliation(s)
- Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Douglas Farquhar
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill
| | - Angela Mazul
- Department of Epidemiology, University of North Carolina, Gillings School of Public Health, Chapel Hill.,now at Division of Hematology-Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Mohammed Mamdani
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Trevor G Hackman
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - D Neil Hayes
- Division of Medical Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill.,now at Division of Hematology-Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Jose P Zevallos
- Department of Epidemiology, University of North Carolina, Gillings School of Public Health, Chapel Hill.,now at Department of Otolaryngology, Washington University in St Louis, School of Medicine, St Louis, Missouri
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Kwan BY, Khan NM, Almeida JR, Goldstein D, Paleri V, Forghani R, Yu E. Transoral robotic surgery for head and neck malignancies: Imaging features in presurgical workup. Head Neck 2019; 41:4018-4025. [DOI: 10.1002/hed.25887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Benjamin Y.M. Kwan
- Department of RadiologyQueen's University Kingston Ontario Canada
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | | | - John R. Almeida
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - David Goldstein
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
| | - Vinidh Paleri
- Head and Neck UnitRoyal Marsden NHS Hospital London UK
| | - Reza Forghani
- Department of RadiologyMcGill University Montreal Quebec Canada
| | - Eugene Yu
- Princess Margaret Cancer CenterUniversity of Toronto Toronto Ontario Canada
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Fakhry C, Zhang Q, Gillison ML, Nguyen-Tân PF, Rosenthal DI, Weber RS, Lambert L, Trotti AM, Barrett WL, Thorstad WL, Yom SS, Wong SJ, Ridge JA, Rao SSD, Spencer S, Fortin A, Raben D, Harris J, Le QT. Validation of NRG oncology/RTOG-0129 risk groups for HPV-positive and HPV-negative oropharyngeal squamous cell cancer: Implications for risk-based therapeutic intensity trials. Cancer 2019; 125:2027-2038. [PMID: 30913305 PMCID: PMC6594017 DOI: 10.1002/cncr.32025] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radiation Therapy Oncology Group (RTOG)-0129 recursive partitioning analysis was the basis for risk-based therapeutic intensification trials for oropharyngeal cancer (OPC). To the authors' knowledge, the question of whether RTOG-0129 overall survival (OS) estimates for low-risk, intermediate-risk, and high-risk groups are similar in other data sets or applicable to progression-free survival (PFS) is unknown. Therefore, the authors evaluated whether survival differences between RTOG-0129 risk groups persist at 5 years, are reproducible in an independent clinical trial, and are applicable to PFS, and whether toxicities differ across risk groups. METHODS Prospective randomized clinical trials were analyzed retrospectively. RTOG-0129 evaluated standard versus accelerated fractionation radiotherapy concurrent with cisplatin. RTOG-0522 compared the combination of cisplatin and accelerated fractionation with or without cetuximab. Patients with OPC with available p16 status and tobacco history were eligible. RESULTS There was a total of 260 patients and 287 patients, respectively, from RTOG-0129 and RTOG-0522, with median follow-ups for surviving patients of 7.9 years (range, 1.7-9.9 years) and 4.7 years (range, 0.1-7.0 years), respectively. Previous OS differences in RTOG-0129 persisted at 5 years. In RTOG-0522, the 5-year OS rates for the low-risk, intermediate-risk, and high-risk groups were 88.1%, 69.9%, and 45.1%, respectively (P for trend, <.001). The 5-year PFS rates for the same 3 groups were 72.9%, 56.1%, and 42.2%, respectively. In RTOG-0522 among a subgroup of patients considered to be at very good risk (p16-positive disease, smoking history of ≤10 pack-years, and classified with T1-T2 disease with ipsilateral lymph nodes measuring ≤6 cm or T3 disease without contralateral or >6 cm lymph nodes), the 5-year OS and PFS rates were 93.8% and 82.2%, respectively. Overall rates of acute and late toxicities were similar by risk group. CONCLUSIONS RTOG-0129 risk groups persisted at 5 years and were reproducible in RTOG-0522. However, there was variability in the estimates. These data underscore the importance of long-term follow-up and appropriate patient selection in therapeutic deintensification trials.
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Affiliation(s)
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
| | - Maura L Gillison
- University of Texas MD Anderson Cancer Center, Houston, TX Center
| | | | | | - Randal S Weber
- University of Texas MD Anderson Cancer Center, Houston, TX Center
| | - Louise Lambert
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - William L Barrett
- University of Cincinnati Cancer Institute, Cincinnati, OH (accruals under Thomas Jefferson University Hospital)
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Sharon Spencer
- University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Andre Fortin
- L’Hotel-Dieu de Quebec, Ville de Québec, QC, Canada
| | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Foster NR, Ginos B, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Olsen KD, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller R, Shiraishi S, Foote RL. Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma. J Clin Oncol 2019; 37:1909-1918. [PMID: 31163012 DOI: 10.1200/jco.19.00463] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL). PATIENTS AND METHODS MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL. RESULTS Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement. CONCLUSION Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.
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Systematic Review of Validated Quality of Life and Swallow Outcomes after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2019; 161:561-567. [DOI: 10.1177/0194599819844755] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To systematically review the available evidence on the effects of transoral robotic surgery (TORS) on the posttreatment quality of life (QOL) and swallow function of patients with head and neck cancer. Data Sources PubMed and Ovid electronic databases were searched from inception to July 6, 2016. Specific database functions were applied to maximize the search. Review Methods Articles in the database were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria. The references of relevant articles were then hand-searched to identify additional manuscripts. For included articles, the study characteristics and relevant data were extracted. Results Of 103 articles screened, 20 reporting validated measures of QOL and/or swallow outcomes for 659 patients were eligible for inclusion. Fourteen were observational studies or case series and did not compare the TORS group with another intervention. Two were prospective nonrandomized clinical trials that compared outcomes between TORS and primary chemoradiation. Four were cohort studies comparing TORS with other treatment approaches and modalities, including open surgical approaches and transoral laser microsurgery. Overall, most patients who underwent TORS ± adjuvant therapy reported a return to baseline QOL and swallow function by 6 to 12 months posttreatment. Several studies demonstrated superior QOL and swallowing outcomes when compared with primary chemoradiation or open approaches. Conclusions Available evidence suggests that patients who undergo TORS for head and neck cancer have good QOL and swallowing outcomes after treatment, but outcomes are dependent on baseline function, T stage, and adjuvant treatment status.
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Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry. Oral Oncol 2019; 91:13-20. [DOI: 10.1016/j.oraloncology.2019.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
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Ibrahim AS, Civantos FJ, Leibowitz JM, Thomas GR, Arnold DJ, Franzmann EJ, Nicolli EA, Lo K, Nemeth Z, Sargi ZB, Weed DT. Meta‐analysis comparing outcomes of different transoral surgical modalities in management of oropharyngeal carcinoma. Head Neck 2019; 41:1656-1666. [DOI: 10.1002/hed.25647] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmed S. Ibrahim
- Department of Surgical OncologyNational Cancer Institute – Cairo University Egypt
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Francisco J. Civantos
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Jason M. Leibowitz
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Giovana R. Thomas
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - David J. Arnold
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Elizabeth J. Franzmann
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Elizabeth A. Nicolli
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Kaming Lo
- Department of Public Health Sciences ‐ Division of BiostatisticsUniversity of Miami Miller School of Medicine Miami Florida
| | - Zsuzsanna Nemeth
- Louis Calder Memorial LibraryUniversity of Miami Miller School of Medicine Miami Florida
| | - Zoukaa B. Sargi
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
| | - Donald T. Weed
- Department of Otolaryngology ‐ Head & Neck SurgeryUniversity of Miami Miller School of Medicine Miami Florida
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Bollig CA, Jorgensen JB. Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer. Head Neck 2019; 41:892-898. [DOI: 10.1002/hed.25482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
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Cramer JD, Ferris RL, Kim S, Duvvuri U. Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment. Oral Oncol 2018; 87:170-176. [PMID: 30527235 DOI: 10.1016/j.oraloncology.2018.10.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). MATERIALS AND METHODS We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2-4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). RESULTS We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43-2.08) or CRT (HR 0.96; CI 0.45-2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification. CONCLUSION We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States.
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Gobillot TA, Kaka AS, Patel SA, Rodriguez C, Cannon RB, Futran ND, Houlton JJ. Treatment of Tonsillar Carcinoma following Nononcologic Tonsillectomy: Efficacy of Transoral Robotic Revision Tonsillectomy. Otolaryngol Head Neck Surg 2018; 160:627-634. [PMID: 30274541 DOI: 10.1177/0194599818802185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate whether transoral robotic surgery (TORS) is a suitable treatment approach for patients diagnosed with tonsillar carcinoma after a standard palatine tonsillectomy. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care medical center. SUBJECTS AND METHODS Patients who underwent TORS at the University of Washington from 2010 to 2017 (n = 150) were identified. All patients who were diagnosed with tonsillar carcinoma following a nononcologic tonsillectomy and subsequently underwent TORS radical tonsillectomy were included (n = 14). Tumor stage-matched subjects (n = 44) were included who did not undergo standard tonsillectomy prior to TORS. Our primary outcome was final margin status. Secondary outcomes were presence of residual tumor, receipt and dose of postoperative adjuvant therapy, disease-free survival (DFS), and disease-specific survival. Patients with <6 months of follow-up following definitive treatment were excluded from survival analyses. RESULTS Final margin status was clear in all subjects. Residual tumor was not identified in 13 of 14 (92.9%) prior-tonsillectomy subjects following TORS radical tonsillectomy. Seven of 14 (50%) prior-tonsillectomy subjects and 12 of 44 (27.3%) TORS-matched subjects did not require adjuvant therapy due to favorable pathology. Among subjects who received post-TORS radiation therapy (RT) at our institution, RT dose reduction was achieved in 3 of 4 (75%) prior-tonsillectomy subjects and 21 of 24 (87.5%) TORS-matched subjects. Ten of 14 (71.4%) prior-tonsillectomy subjects and 31 of 44 (70.5%) TORS-matched subjects avoided post-TORS chemotherapy. DFS was not significantly different ( P = .87) between prior-tonsillectomy and TORS-matched groups, and no subjects died of related disease. CONCLUSIONS Patients diagnosed with tonsillar carcinoma following a prior nononcologic standard palatine tonsillectomy are suitable candidates for revision surgery with TORS radical tonsillectomy.
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Affiliation(s)
- Theodore A Gobillot
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Azeem S Kaka
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Sapna A Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Cristina Rodriguez
- 2 Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington, USA
| | - Richard B Cannon
- 3 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery (R.B.C.), University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Neal D Futran
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey J Houlton
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Windon MJ, D'Souza G, Fakhry C. Treatment preferences in human papillomavirus-associated oropharyngeal cancer. Future Oncol 2018; 14:2521-2530. [PMID: 30265132 PMCID: PMC6275561 DOI: 10.2217/fon-2018-0063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/09/2018] [Indexed: 01/18/2023] Open
Abstract
The population of survivors with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) is rising. The improved prognosis of this etiologic subset is reflected in new staging guidelines as well as ongoing deintensification trials aiming to preserve excellent survival while decreasing treatment-related toxicities. However, as staging criteria and treatment standards evolve in the era of transoral surgery and deintensification, little is known regarding the needs and treatment preferences of patients with HPV-OPSCC. Herein, the current knowledge regarding treatment preferences and priorities, quality of life and concerns among patients with HPV-OPSCC is reviewed.
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Affiliation(s)
- Melina J Windon
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Bloomberg–Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Heah H, Goepfert RP, Hutcheson KA, Garden AS, Gunn GB, Fuller CD, Lewin JS, Kupferman ME, Holsinger FC, Hessel AC, Gross ND. Decreased gastrostomy tube incidence and weight loss after transoral robotic surgery for low- to intermediate-risk oropharyngeal squamous cell carcinoma. Head Neck 2018; 40:2507-2513. [DOI: 10.1002/hed.25382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/29/2018] [Accepted: 05/28/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Harold Heah
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Otolaryngology; Singapore General Hospital; Singapore
| | - Ryan P. Goepfert
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Adam S. Garden
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - G. Brandon Gunn
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Clifton D. Fuller
- Department of Radiation Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jan S. Lewin
- Department of Otolaryngology; Singapore General Hospital; Singapore
| | - Michael E. Kupferman
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - F. Christopher Holsinger
- Department of Otolaryngology - Head and Neck Surgery; Stanford University Medical Center; Stanford California
| | - Amy C. Hessel
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Neil D. Gross
- Department of Head and Neck Surgery; University of Texas MD Anderson Cancer Center; Houston Texas
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White J, Sharma A. Development and Assessment of a Transoral Robotic Surgery Curriculum to Train Otolaryngology Residents. ORL J Otorhinolaryngol Relat Spec 2018; 80:69-76. [PMID: 29847824 DOI: 10.1159/000479744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
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Abstract
While treatments for head and neck cancer are aimed at curing patients from disease, they can have significant short- and long-term negative impacts on speech and swallowing functions. Research demonstrates that early and frequent involvement of Speech-Language Pathologists (SLPs) is beneficial to these functions and overall quality of life for head and neck cancer patients. Strategies and tools to optimize communication and safe swallowing are presented in this chapter.
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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 25:101-107. [PMID: 28106661 DOI: 10.1097/moo.0000000000000340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. RECENT FINDINGS Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. SUMMARY Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice.
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Persky MJ, Albergotti WG, Rath TJ, Kubik MW, Abberbock S, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 158:660-666. [PMID: 29182490 DOI: 10.1177/0194599817742852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
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Affiliation(s)
- Michael J Persky
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - William G Albergotti
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanya J Rath
- 3 Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Kubik
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shira Abberbock
- 4 Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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McClellan J, Achim V, Clayburgh D. Small bowel obstruction after transoral robotic surgery. Head Neck 2017; 40:E9-E12. [PMID: 29120518 DOI: 10.1002/hed.24989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/07/2017] [Accepted: 09/15/2017] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Head and neck surgery is not often considered a risk factor for intestinal ileus and small bowel obstruction. However, many of these patients may have had prior abdominal surgery, a known risk factor for small bowel obstruction, and may be at risk for bowel obstruction after a surgical procedure of the head and neck. METHODS We present a case describing a patient who, after undergoing transoral robotic surgery, experienced delayed postoperative ileus and eventual small bowel obstruction requiring exploratory laparotomy and bowel resection. RESULTS Although the patient required total parenteral nutrition for several days, he eventually was able to resume tube feeds, and after several months was able to tolerate an oral diet. CONCLUSION Although uncommon complications of head and neck surgery, intestinal ileus and small bowel obstruction can develop as the result of stress/inflammation, postoperative narcotic pain medication, and prior abdominal surgery.
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Affiliation(s)
- Joseph McClellan
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Virginie Achim
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Daniel Clayburgh
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Achim V, Bolognone RK, Palmer AD, Graville DJ, Light TJ, Li R, Gross N, Andersen PE, Clayburgh D. Long-term Functional and Quality-of-Life Outcomes After Transoral Robotic Surgery in Patients With Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2017; 144:18-27. [PMID: 29075740 DOI: 10.1001/jamaoto.2017.1790] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance In recent years, transoral robotic surgery (TORS) has emerged as a useful treatment for oropharyngeal squamous cell carcinoma (OPSCC). In appropriately selected patients, the use of TORS may allow avoidance of adjuvant chemotherapy and/or radiotherapy, thereby avoiding the long-term adverse effects of these therapies. Objective To compare functional speech, swallowing, and quality-of-life outcomes longitudinally between those undergoing TORS only and those undergoing TORS and adjuvant radiotherapy (TORS+RT) or TORS and chemoradiotherapy (TORS+CRT). Design, Setting, and Participants This prospective, longitudinal cohort study performed from June 1, 2013, through November 31, 2015, included 74 patients undergoing TORS for initial treatment of OPSCC at a single tertiary academic hospital. Main Outcomes and Measures Data were collected at baseline, postoperatively (7-21 days), at short-term follow-up (6-12 months), and at long-term follow-up (>12 months). The quality-of-life metrics included the 10-item Eating Assessment Tool and the University of Michigan Head and Neck Quality of Life instrument. Data were also collected on tumor staging, surgical and adjuvant therapy details, patient comorbidities, tracheostomy and feeding tube use, and functional speech and swallowing status using the Performance Status Scale for Head and Neck Cancer Patients. Results Seventy-four patients were enrolled in the study (mean [SD] age, 61.39 [7.99] years; 68 [92%] male). Median long-term follow-up was 21 months (range, 12-36 months). The response rates were 86% (n = 64) postoperatively, 88% (n = 65) at short-term follow-up, and 86% (n = 64) at long-term follow-up. In all 3 groups, there was a significant worsening in pain and all swallowing-related measures postoperatively. There was subsequent improvement over time, with different trajectories observed across the 3 intervention groups. Postoperative dysphagia improved significantly more quickly in the TORS-only group. At long-term follow-up, weight loss differed between the TORS-only and TORS+RT groups (mean difference, -16.1; 97.5% CI, -29.8 to -2.4) and the TORS-only and TORS+CRT groups (mean difference, -14.6; 97.5% CI, -29.2 to 0) in a clinically meaningful way. In addition, the TORS-only group had significantly better scores than the TORS+CRT group on the Performance Status Scale-Eating in Public scale (mean difference, 21.8; 97.5% CI, 4.3-39.2) and Head and Neck Quality of Life-Eating scale (mean difference, 21.2; 97.5% CI, 4.0-38.3). Conclusions and Relevance Patients who underwent TORS+CRT demonstrated poorer long-term outcomes, with continued dysphagia more than 1 year after surgery. These findings support the investigation of adjuvant de-escalation therapies to reduce the long-term adverse effects of treatment.
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Affiliation(s)
- Virginie Achim
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Rachel K Bolognone
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Andrew D Palmer
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Donna J Graville
- The Northwest Clinic for Voice and Swallowing, Oregon Health and Science University, Portland
| | - Tyler J Light
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Ryan Li
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Neil Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Peter E Andersen
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Daniel Clayburgh
- Department of Head and Neck Surgery, Oregon Health and Science University, Portland
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Turner MT, Byrd JK, Ferris RL. Current Role of Surgery in the Management of Oropharyngeal Cancer. J Oncol Pract 2017; 12:1176-1183. [PMID: 27858544 DOI: 10.1200/jop.2016.015263] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The 1990s saw an increased use of chemoradiotherapy protocols, commonly referred to as organ-sparing therapy, for the treatment of oropharyngeal cancer after the Groupe d'Oncologie Radiothérapie Tête et Cou trial. Since that time, human papillomavirus-associated oropharyngeal squamous cell carcinoma has been identified as a unique disease, with improved survival regardless of treatment modality. The improved outcomes of this population has led to re-evaluation of treatment paradigms in the past decade, with a desire to spare young, human papillomavirus-positive patients the treatment-related toxicities of chemoradiotherapy and to use new minimally invasive surgical techniques to improve outcomes. Numerous retrospective and prospective studies have investigated the role of surgery in treatment of oropharyngeal carcinoma and have demonstrated equivalent oncologic outcomes and improved functional outcomes compared with chemoradiotherapy protocols. Ongoing and future clinical trials may help delineate the role of surgery in the future.
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Affiliation(s)
- Meghan T Turner
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - J Kenneth Byrd
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
| | - Robert L Ferris
- University of Pittsburgh Medical Center, Pittsburgh, PA; and Medical College of Georgia at Augusta University, Augusta, GA
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Gastrostomy in the era of minimally invasive head and neck cancer surgery. Laryngoscope 2017; 128:847-851. [DOI: 10.1002/lary.26829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/21/2017] [Accepted: 07/05/2017] [Indexed: 11/07/2022]
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Sethia R, Yumusakhuylu AC, Ozbay I, Diavolitsis V, Brown NV, Zhao S, Wei L, Old M, Agrawal A, Teknos TN, Ozer E. Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer. Laryngoscope 2017; 128:403-411. [PMID: 28771728 DOI: 10.1002/lary.26796] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare quality of life (QOL) of patients who underwent transoral robotic surgery (TORS) alone, with adjuvant radiation therapy (RT), or adjuvant chemoradiation therapy (CRT) in the treatment of oropharyngeal squamous cell cancer (OPSCCA). STUDY DESIGN Prospective cohort study. METHODS Medical records were reviewed for 111 patients treated for OPSCCA from 2008 to 2015. Patients were administered the Head and Neck Cancer Inventory (HNCI) to evaluate QOL preoperatively, and at 3 weeks, 3 months, 6 months, and 1 year postsurgery. QOL data were compared between 13 patients treated with TORS alone, 31 with adjuvant RT, and 67 with adjuvant CRT by a linear mixed effects model. RESULTS Mean follow-up was 35 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 80%, 60%, 55%, and 46%, respectively. TORS alone reported significantly higher eating scores than adjuvant RT or CRT at 3 and 6 months, and higher speech scores compared to adjuvant CRT at 3 months and adjuvant RT at 6 months. TORS alone and adjuvant RT reported less social disruption compared to adjuvant CRT at 3 months. Adjuvant CRT had consistently lower overall QOL scores until 6 months. No TORS-alone patient required percutaneous endoscopic gastrostomy, and no study patient required tracheostomy during treatment. CONCLUSIONS TORS alone maintained higher QOL than adjuvant RT or CRT in eating, social function, speech, and overall QOL postsurgery. QOL and functional metrics were better for 6 months in TORS-alone patients, and at 12 months, the differences were not significant. LEVEL OF EVIDENCE 4. Laryngoscope, 128:403-411, 2018.
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Affiliation(s)
- Rishabh Sethia
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Ali C Yumusakhuylu
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Isa Ozbay
- Department of Otolaryngology, Dumlupinar University, Kutahya, Turkey.,Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Virginia Diavolitsis
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Nicole V Brown
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Songzhu Zhao
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.,Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, U.S.A
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Controversies in Postoperative Irradiation of Oropharyngeal Cancer After Transoral Surgery. Surg Oncol Clin N Am 2017; 26:357-370. [DOI: 10.1016/j.soc.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer 2017; 78:91-102. [DOI: 10.1016/j.ejca.2017.03.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/24/2016] [Accepted: 03/06/2017] [Indexed: 01/13/2023]
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Schoppy DW, Kupferman ME, Hessel AC, Bell DM, Garland EM, Damrose EJ, Holsinger FC. Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx. CANCERS OF THE HEAD & NECK 2017; 2:5. [PMID: 31093352 PMCID: PMC6460795 DOI: 10.1186/s41199-017-0024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
Abstract
Background Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence. Conclusion In this experience, transoral eHNS provided a safe and consistent surgical approach to management of minor salivary gland malignancies, with low complication rates and good locoregional control. Thus, transoral eHNS may play a valuable role in the multi-disciplinary management of these malignancies. Trial registration number None/not applicable Electronic supplementary material The online version of this article (doi:10.1186/s41199-017-0024-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David W Schoppy
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - Michael E Kupferman
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Amy C Hessel
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Diana M Bell
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Elizabeth M Garland
- 2Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Edward J Damrose
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
| | - F Christopher Holsinger
- 1Division of Head and Neck Surgery, Department of Otolaryngology, Stanford Cancer Center, Stanford University School of Medicine, 875 Blake Wilbur Drive, CC-2227, Palo Alto, CA 94304 USA
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Albergotti WG, Jordan J, Anthony K, Abberbock S, Wasserman-Wincko T, Kim S, Ferris RL, Duvvuri U. A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 2017; 123:3132-3140. [PMID: 28467606 DOI: 10.1002/cncr.30712] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology compared with chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study was to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were enrolled prospectively. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score >2) and was administered on postoperative day (POD) 1, 7, and 30. Patient demographics, weight, pain level, and clinical outcomes were recorded prospectively and focused on time to oral diet, feeding tube placement, and dysphagia-related readmissions. RESULTS A total of 51 patients were included with pathologic T stages of T1 (n = 24), T2 (n = 20), T3 (n = 3), and Tx (n = 4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD 1 was lower than on POD 7 (21.5 vs 26.6; P = .005) but decreased by POD 30 (26.1 to 12.2; P < .001). Forty-seven (92.1%) patients were discharged on an oral diet, but 57.4% required compensatory strategies or modification of liquid consistency. Ninety-eight percent of patients were taking an oral diet by POD 30. There were no dysphagia-related readmissions. CONCLUSION This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month postoperatively, but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions. Cancer 2017;123:3132-40. © 2017 American Cancer Society.
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Affiliation(s)
- William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jessica Jordan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keely Anthony
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shira Abberbock
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
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