Surgical Options for Locally Advanced Oropharyngeal Cancer
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Oropharyngeal squamous cell carcinoma (OPSCC) incidence rates have been steadily increasing over the past several decades, and this has been largely attributed to human papillomavirus (HPV)-related OPSCC. The rise of HPV-related OPSCC and the observed distinct survival advantage it offers compared to HPV-unrelated OPSCC have resulted in the development of a new staging system specifically for OPSCC in the eighth edition of the AJCC Staging Manual for head and neck cancer. The observations on HPV-related OPSCC and its prognostic implications have coincided with increasing utilization of transoral surgical approaches to oropharyngeal tumors, such as transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). These approaches were once thought to only be applicable to patients with low T-stage OPSCC tumors; however, they are being increasingly utilized in locally advanced OPSCC cases as several studies have shown that both of these transoral approaches are oncologically sound alternatives to concurrent chemoradiation therapy (CCRT), which was previously the standard-of-choice treatment in patients with locally advanced disease. Moreover, these transoral approaches have displayed better long-term swallowing outcomes compared to CCRT, as severe dysphagia is often the most bothersome functional impairment to OPSCC survivors who have undergone CCRT. While open surgical approaches were previously not utilized in the locally advanced OPSCC setting due to the risk of severe surgical complications compared to the potential benefits of organ preservation with CCRT and comparable survival rates after either treatment regimen, these approaches are still reasonable options for select patients in the salvage surgery setting, as they allow for maximum exposure to the deep oropharyngeal anatomy. Data from multiple clinical trials evaluating the potential for TORS to de-escalate radiation dose or CCRT regimen in certain settings will inform clinical decision-making for OPSCC patients for the next decade and allow for more personalized treatments tailored to an individual patient’s disease burden.
KeywordsOropharyngeal squamous cell carcinoma Transoral robotic surgery Transoral laser microsurgery Human papillomavirus-related cancer
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The authors declare that they have no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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- 5.•• Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, et al. Head and neck cancers—major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(2):122–37 Introduced major changes to the clinical and pathologic staging of oropharyngeal cancers.CrossRefGoogle Scholar
- 12.Masterson L, Moualed D, Liu ZW, Howard JE, Dwivedi RC, Tysome JR, et al. De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials. Eur J Cancer. 2014;50(15):2636–48.CrossRefGoogle Scholar
- 22.Bhayani MK, Holsinger FC, Lai SY. A shifting paradigm for patients with head and neck cancer: transoral robotic surgery (TORS). Oncology (Williston Park). 2010;24(11):1010–5.Google Scholar
- 24.• de Almeida JR, Byrd JK, Wu R, Stucken CL, Duvvuri U, Goldstein DP, et al. A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope. 2014;124(9):2096–102 A large systematic review comparing effectiveness of TORS versus IMRT for early T-stage oropharyngeal cancer.CrossRefGoogle Scholar
- 26.Weinstein GS, Quon H, O’Malley BW, Kim GG, Cohen MA. Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial. Laryngoscope. 2010;120(9):1749–55.CrossRefGoogle Scholar
- 30.Kelly JR, Park HS, An Y, Contessa JN, Yarbrough WG, Burtness BA, et al. Comparison of survival outcomes among human papillomavirus-negative cT1-2 N1-2b patients with oropharyngeal squamous cell cancer treated with upfront surgery vs definitive chemoradiation therapy: an observational study. JAMA Oncol. 2017;3(8):1107–11.CrossRefGoogle Scholar
- 32.Butlin HT. Diseases of the tongue. London: Cassel & Company; 1885. p. 324–32.Google Scholar
- 42.• Owadally W, Hurt C, Timmins H, Parsons E, Townsend S, Patterson J, et al. PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for human papillomavirus (HPV) positive oropharyngeal cancer. BMC Cancer. 2015;15:602 A multicenter phase II/III randomized controlled trial stratifying patients with HPV-positive OPSCC undergoing TORS resection into groups based on pathological risk factors for recurrence for adjuvant treatment.CrossRefGoogle Scholar