Decreased Gastrostomy Tube Incidence And Weight Loss After Trans-oral Robotic Surgery For Early Oropharyngeal Squamous Cell Carcinoma

Presentation: S222
Topic: Oropharynx
Type: Oral
Date: Monday, July 18, 2016
Session: 3:45 PM - 5:15 PM Oral Cavity and Oropharynx
Authors: Harold Heah1, Kate Hutcheson, PhD1, Ryan Goepfert, MD1, Adam S Garden, MD1, Clifton D Fuller, MD, PhD1, Michael E Kupferman, MD1, Christopher F Holsinger, MD2, Gary B Gunn, MD1, Jan S Lewin, PhD1, Neil D Gross, MD1
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Institution(s): 1UT MD Anderson Cancer Center, 2Stanford University Medical Center
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Background: Transoral robotic surgery (TORS) has been established as a safe and effective treatment option for selected patients with oropharyngeal squamous cell carcinoma (OPSCC).  However, scant data exists regarding functional outcomes after TORS for OPSCC. This study investigated the incidence of gastrostomy (G) tube use and weight loss in OPSCC patients treated with primary TORS compared to those treated non-surgically.

Methods: We performed a retrospective study comparing two groups of OPSCC patients treated at MD Anderson Cancer Center; 1) TORS +/- adjuvant therapies, 2) radiation +/- chemotherapy. Inclusion criteria were previously untreated T1-2, N0-2b OPSCC of the tonsil or base of tongue. Patients who had a G-tube placed prophylactically or who were G-tube dependent at initiation of treatment were excluded.

The primary outcome measures were incidence of G-tube placement and severity of weight loss, according to CTCAE criteria, from initiation of treatment to 3 months post-treatment. Multivariate regression models were fit to compare g-tube utilization and weight loss between groups.

Results: There were 66 OPSCC patients in the TORS group and 156 in the non-surgical group. Compared to the non-surgical group, patients treated with TORS were more likely to have a tonsil primary (p=0.006), lower T class (p=0.045) and lower N class (p<0.001). Thirty-two (48.5%) of the TORS patients received adjuvant radiation +/- chemotherapy (mean dose: 61.5Gy, range: 50 to 66Gy). 118 (75%) of the non-surgical patients received chemotherapy compared to 16 (24%) of the patients treated with TORS (p<0.001). The mean dose of radiation in the non-surgical group was 67.5Gy (range: 66 to 70Gy).  G-tube incidence was 6.1% and 44.6% in the TORS and non-surgical groups respectively (p<0.001). Grade 3 weight loss (>20% or requiring G-tube placement) was 9.7% and 51% in the TORS and non-surgical groups respectively (p < 0.001). Controlling for baseline differences in multivariate models, incidence of G-tube placement and percent weight loss were statistically significant between groups. On multivariate analysis, patients treated non-surgically were 10.6x more likely to have a G-tube placed (OR: 10.6, 95% CI: 3.6-31.1). A sensitivity analysis using propensity score matching yielded similar results.

Conclusions: OPSCC patients selected for TORS as primary treatment had a significantly lower incidence of G-tube placement and critical weight loss compared to those treated non-surgically. The use of TORS in low-risk OPSCC may help avoid critical weight loss and the need for a G-tube, and should be discussed when considering treatment strategies.

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