First line surgical treatment of Oropharyngeal Carcinoma with Trans-Oral Robotic Surgery (TORS): Review of a single institutions outcomes

Presentation: C047
Topic: Pharynx / Larynx Cancer
Type: Poster
Date: Thursday, April 19, 2018
Session: 9:00 AM - 7:00 PM
Authors: Julia A Crawford, MD, Brett Leavers, Dr, Richard M Gallagher
Institution(s): St Vincent's Hospital Sydney

Background: Unlike other head and neck cancer subsites, the incidence of oropharyngeal carcinoma is increasing due to the rising number of Human Papilloma Virus (HPV) related squamous cell carcinomas (SCC). HPV-related oropharyngeal squamous cell carcinoma (OPSCC) represents a growing etiologically distinct subset of head and neck cancers with unique epidemiological, clinical, and molecular characteristics that differ from those of HPV-negative cancers. Since around 2002, oropharyngeal carcinoma has predominantly been treated with primary radiation +/- the addition of chemotherapy. There is now building evidence for treating these cancers surgically via the transoral route with the addition of adjuvant radiotherapy +/- chemotherapy based on pathological staging. The St Vincent’s Hospital network was one of the forerunners in Australia for adopting this treatment strategy. The following is a review of outcomes from this treatment paradigm.  

Methods: Retrospective review of a prospectively collected database of patients treated with transoral robotic surgical resection (TORS) for OPSCC at St Vincent’s Private and Public Hospital in Sydney, Australia. All surgeries were performed by the senior author. Inclusion criteria included a biopsy proven diagnosis of SCC and surgical treatment of the primary tumour with TORS. Exclusion criteria included histological subtype other than the SCC, any previous treatment for carcinoma of the head and neck, unknown primary disease and primary site other than the oropharynx.

Results: A total of 95 patients from December 2011 to October 2017 were treated for oropharyngeal carcinoma at St Vincent’s Hospital with TORS for the primary tumour and either synchronous or staged neck dissections. This consisted of 80 men and 15 women with a mean age of 60. The subsites were Base of tongue in 49 and Tonsil in 46. The overall staging was Stage 1 in 6.3% (n6), Stage 2 in 9% (n8), Stage 3 in 22% (n21) and Stage 4 in 57% (n60). 87 patients had T1 and T2 tumours, 8 had T3 tumours. P16 status was positive in 74 patients and negative in 3 patients.  Overall 49% of patients required surgery alone as their primary treatment. Adjuvant therapy occurred in 51% of patients of which 14% required bimodality treatment and 37% trimodality. 3- year locoregional control rate was 88.1%, 3 year disease specific survival was 92.5% and overall survival was 89.6%.  The rate of PEG and tracheostomy insertion was 1.1%.

Conclusion: These results add to the growing evidence that TORS is an appropriate treatment pathway for patients with oropharyngeal carcinoma. This particularly applies to patients with HPV positive disease who at the present time are being over treated.