Minimizing adjuvant treatment after transoral robotic surgery through surgical margin revision and exclusion of radiographic extracapsular extension: A Prospective observational cohort study

Head Neck. 2017 May;39(5):965-973. doi: 10.1002/hed.24712. Epub 2017 Feb 11.

Abstract

Background: We investigated in a prospective cohort of patients treated with trans-oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra-capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo-radiation therapy (CRT) without jeopardizing tumor control and functional outcome.

Methods: We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer.

Results: Twenty-nine patients with T1/2N0 to N2B stage cancers were treated with TORS. Forty-five percent of them were treated for secondary primaries. Nine of 29 patients (31%) were revised for close/positive margins. Adjuvant RT was prescribed for 2 of 19 patients with early squamous cell carcinoma (SCCs) and CRT for 1 of 10 patients with advanced oropharyngeal SCCs. Overall survival (OS), disease-specific survival (DSS), and locoregional control at 2 years were 85%, 96%, and 93%, respectively. Posttreatment Functional Outcome Swallowing Scale (FOSS) scores worsened with prior or adjuvant RT, local recurrence, site, and revision for margins.

Conclusion: Patients with early and moderately advanced oropharyngeal SCC selected for radiographic ECS and revised for inadequate margins have excellent tumor control and favorable functional recovery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 965-973, 2017.

Keywords: Functional Outcome Swallowing Scale (FOSS) score; head and neck cancer; head and neck squamous cell carcinoma (HNSCC); oropharyngeal neoplasm; transoral robotic surgery (TORS).

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / therapy*
  • Female
  • Humans
  • Male
  • Margins of Excision
  • Middle Aged
  • Oropharyngeal Neoplasms / mortality
  • Oropharyngeal Neoplasms / pathology*
  • Oropharyngeal Neoplasms / therapy*
  • Prospective Studies
  • Radiotherapy, Adjuvant
  • Robotic Surgical Procedures*
  • Survival Rate
  • Treatment Outcome