Predictors of swallow function after transoral surgery for locally advanced oropharyngeal cancer

2019 ◽  
Vol 130 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Jennifer H. Gross ◽  
Melanie Townsend ◽  
Helena Y. Hong ◽  
Emily Miller ◽  
Dorina Kallogjeri ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Locally Advanced ◽  
Transoral Surgery ◽  
Swallow Function

scholarly journals Novel Strategies to Effectively De-escalate Curative-Intent Therapy for Patients With HPV-Associated Oropharyngeal Cancer: Current and Future Directions

2020 ◽  
pp. 257-269
Author(s):  
Katharine A. R. Price ◽  
Anthony C. Nichols ◽  
Colette J. Shen ◽  
Almoaidbellah Rammal ◽  
Pencilla Lang ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Phase Iii ◽  
Locoregional Therapy ◽  
Transoral Surgery ◽  
Curative Intent ◽  
Definitive Radiotherapy ◽  
Radiotherapy Alone ◽  
Novel Biomarkers

The treatment of patients with HPV-associated oropharyngeal cancer (HPV-OPC) is rapidly evolving and challenging the standard of care of definitive radiotherapy with concurrent cisplatin. There are numerous promising de-escalation strategies under investigation, including deintensified definitive chemoradiotherapy, transoral surgery followed by de-escalated adjuvant therapy, and induction chemotherapy followed by de-escalated locoregional therapy. Definitive radiotherapy alone or with cetuximab is not recommended for curative-intent treatment of patients with locally advanced HPV-OPC. The results of ongoing phase III studies are awaited to help answer key questions and address ongoing controversies to transform the treatment of patients with HPV-OPC. Strategies for de-escalation under investigation include the incorporation of immunotherapy and the use of novel biomarkers for patient selection for de-escalation.

Comparative effectiveness trial of transoral head and neck surgery followed by adjuvant radio(chemo)therapy versus primary radiochemotherapy for oropharyngeal cancer (TopROC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS6093-TPS6093 ◽  
Author(s):  
Chia-Jung Busch ◽  
Simon Laban ◽  
Claus Wittekindt ◽  
Carmen Stromberger ◽  
Silke Tribius ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Oropharyngeal Cancer ◽  
Comparative Effectiveness ◽  
Salvage Surgery ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Standard Of Care ◽  
Transoral Surgery ◽  
Open Label ◽  
Patient Reported

TPS6093 Background: For locally advanced, transorally resectable oropharyngeal cancer (OPSCC), both, surgical resection and risk-adapted adjuvant (chemo)radiotherapy or definite chemoradiotherapy with or without salvage surgery are considered the current standard of care. To date, these two different therapeutic approaches for transorally resectable OPSCC have not been compared head to head in a randomized trial yet. The goal of this study is to compare primary transoral surgery followed by adjuvant treatment with definitive chemoradiation for resectable OPSCC, especially with regards to loco-regional control as well as organ function. Methods: TopROC is a prospective, two-arm, open label, multicenter, randomized controlled comparative effectiveness study. Eligible pts. are ≥18 years old with treatment-naïve, histologically proven OPSCC (T1, N2a-c, M0; T2, N1-2c, M0; T3, N0-2c, M0 TNM 7th ed.) which are amenable to transoral resection, ECOG PS ≤2 and no distant metastasis. p16 immunohistochemistry by local pathology or FFPE tissue must be available for central diagnostic. 280 pts. will be randomly assigned (1:1) to surgical treatment (arm A) or chemoradiation (arm B). Standard of care treatment will be done according to daily clinical practice. Arm A consists of transoral surgical resection with neck dissection followed by risk-adapted adjuvant (chemo)radiation. Pts. treated in arm B receive standard chemoradiation, residual tumor may be subject to salvage surgery. Follow-up visits are planned until three years after treatment. Primary endpoint is time to local or locoregional failure or death from any cause (LRF). Secondary endpoints include overall and disease-free survival, toxicity, patient reported outcomes and cost-effectiveness analysis. Approximately 20 centers will be involved in Germany. This trial is supported by the German Cancer Aid and accompanied by a large scientific support program. Recruitment started in January 2018. Clinical trial information: NCT03691441.

scholarly journals Modern Treatment Outcomes for Early T-Stage Oropharyngeal Cancer Treated With Intensity-modulated Radiation Therapy at a Tertiary Care Institution

2020 ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract BackgroundTransoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT.MethodsConsecutive cases of early T stage (T1-T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014-2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the CTCAE criteria.ResultsA total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p=0.0026). ConclusionsPrimary RT or CRT provides outstanding survival for early T-stage HPV-positive disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy

2018 ◽  
Vol 27 (4) ◽  
pp. 643-649 ◽  
Author(s):  
Giancarlo Tirelli ◽  
Francesca Boscolo Nata ◽  
Marco Piovesana ◽  
Eliana Quatela ◽  
Nicoletta Gardenal ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Transoral Surgery

Updated report of a phase II randomized trial of transoral surgical resection followed by low-dose or standard postoperative therapy in resectable p16+ locally advanced oropharynx cancer: A trial of the ECOG-ACRIN cancer research group (E3311).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6010-6010
Author(s):  
Robert L. Ferris ◽  
Yael Flamand ◽  
Gregory S. Weinstein ◽  
Shuli Li ◽  
Harry Quon ◽  
...  
Keyword(s):  
Phase Ii ◽  
Standard Dose ◽  
Locally Advanced ◽  
Oncologic Outcome ◽  
Smoking History ◽  
Transoral Surgery ◽  
P Value ◽  
Oropharynx Cancer ◽  
Patient Reported

6010 Background: Definitive or postoperative chemoradiation (CRT) is highly curative for human papillomavirus-associated (HPV+) oropharynx cancer (OPC) but induces significant toxicity. As a potential deintensification strategy, we studied primary transoral surgery (TOS) and, in intermediate pathologic risk patients, reduced dose postoperative RT (PORT). Methods: E3311 is a phase II trial with randomization to reduced- or standard-dose PORT for resected stage III-IVa (AJCC7) intermediate pathologic risk HPV+ OPC, stratified by smoking history. Primary endpoints have been reported; we now present updated 3-year PFS and patient-reported outcomes (PRO), including head and neck-cancer specific quality of life (FACT-H&N) and swallowing perception and performance (MDADI). Results: Of 519 enrolled patients, 495 underwent TOS. The primary oncologic endpoint was 2-year PFS for 50 Gy (Arm B) or 60Gy (Arm C). Among 360 eligible and treated patients (ETP), Arm A (observation, N = 38) enrolled 11%, Arms B (N = 100) or C (N = 109) randomized 58%, and Arm D (66Gy + weekly cisplatin, N = 113) enrolled 31%. With 35.1 months median follow-up, 3-year PFS Kaplan-Meier estimate is 96.9% (90% CI [91.9%, 100%]) for Arm A; 94.9% (90% CI [91.3%, 98.6%]) for Arm B; 93.5% (90% CI [89.4%, 97.9%]) for Arm C; and 90.7% (90% CI [86.2%, 95.4%]) for Arm D. Recurrences and death without recurrence were 4 and 1 in Arm B, and 5 and one in Arm C. Smokers ( > 10 pack-years) did not have worse 3-year PFS in Arms B or C. Treatment arm distribution and outcome for ineligible patients who started adjuvant therapy mirrored the 360 ETP. A comparison combining arms B/C versus arm D in the proportion of patients stable/improved in FACT-H&N total score, from baseline to 6 months post-treatment as a pre-specified endpoint, was 56% vs. 38% (p value = 0.011, one-sided Fisher’s exact test); however, underlying differences in treatment and risk may be confounding. An exploratory comparison between Arms B and C revealed improvement in FACT H&N (63% in Arm B vs. 49% in Arm C had a stable/improved score, p-value = 0.056). Conclusions: Primary TOS and reduced PORT retained outstanding oncologic outcome at 35 months follow up, with favorable QOL and functional outcomes, in intermediate risk HPV+ OPC. Clinical trial information: NCT 01898494.

scholarly journals Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Eric J. Di Gravio ◽  
Pencilla Lang ◽  
Hugh Andrew Jinwook Kim ◽  
Tricia Chinnery ◽  
Neil Mundi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Oropharyngeal Cancer ◽  
Early Stage ◽  
Tertiary Care ◽  
Feeding Tube ◽  
The United States ◽  
Transoral Robotic Surgery ◽  
Transoral Surgery ◽  
Severe Toxicity ◽  
T Stage

Abstract Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.

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