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Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach

Lookup NU author(s): Dr Max RobinsonORCiD

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Abstract

Background The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM).Methods A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high-risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan-Meier statistics.Results Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV-positive (n = 101; 66.0%). Three-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV-positivity portended favorable oncologic outcomes. One-year gastrostomy tube (G-tube) dependency was 1.3%.Conclusion To the best of our knowledge, this is the largest single-center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/- postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages.

Publication metadata

Author(s): Wilkie MD, Upile NS, Lau AS, Williams SP, Sheard J, Helliwell TR, Robinson M, Rodrigues J, Beemireddy K, Lewis-Jones H, Hanlon R, Husband D, Shenoy A, Roland NJ, Jackson SR, Bekiroglu F, Tandon S, Lancaster J, Jones TM

Publication type: Article

Publication status: Published

Journal: Head & Neck

Year: 2016

Volume: 38

Issue: 8

Pages: 1263-1270

Print publication date: 01/08/2016

Online publication date: 04/04/2016

Acceptance date: 13/01/2016

ISSN (print): 1043-3074

ISSN (electronic): 1097-0347

Publisher: John Wiley & Sons, Inc.

URL: http://dx.doi.org/10.1002/hed.24432

DOI: 10.1002/hed.24432

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