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Dalton CL, Milinis K, Houghton D, Ridley P, Davies K, Williams R, Hamilton D, Wilkie MD, Markey A, Clarke K, Lofthouse M, Helliwell TR, Triantafyllou A, Rodrigues J, Bheemireddy K, Hanlon R, Wieshmann H, Haridass A, Brammer C, Husband D, Shenoy A, Loh C, Roland NJ, Bekiroglu F, Tandon S, Lancaster J, Jones TM. Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care. Eur J Surg Oncol 2020; 46:2042-2049. [PMID: 32893045 DOI: 10.1016/j.ejso.2020.06.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION We describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported. MATERIALS AND METHODS This retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis. RESULTS 264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16-0.49, p < 0.0001), DFS (HR 0.28, CI 0.17-0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09-0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%. CONCLUSIONS TLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.
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Affiliation(s)
- C Lucy Dalton
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Kristijonas Milinis
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - David Houghton
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Oral and Maxillofacial Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Paul Ridley
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Katharine Davies
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Richard Williams
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - David Hamilton
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Mark D Wilkie
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Anne Markey
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Otorhinolaryngology-Head and Neck Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Middlewich Road, Crewe, Cheshire, CW1 4QJ, United Kingdom
| | - Kim Clarke
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Matthew Lofthouse
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Timothy R Helliwell
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Cellular Pathology, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, United Kingdom
| | - Asterios Triantafyllou
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Cellular Pathology, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, United Kingdom
| | - Jennifer Rodrigues
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Krishna Bheemireddy
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Rebecca Hanlon
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Hulya Wieshmann
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Anoop Haridass
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Caroline Brammer
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - David Husband
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Aditya Shenoy
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, United Kingdom
| | - Christopher Loh
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Nicholas J Roland
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Fazilet Bekiroglu
- Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom; Department of Oral and Maxillofacial Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - Sankalap Tandon
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Jeffrey Lancaster
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom
| | - Terence M Jones
- Department of Otorhinolaryngology-Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom; Liverpool Head and Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 200 London Road, Liverpool, L3 9GA, United Kingdom.
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