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Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach
Author(s) -
Wilkie Mark D.,
Upile Navdeep S.,
Lau Andrew S.,
Williams Stephen P.,
Sheard Jon,
Helliwell Tim R.,
Robinson Max,
Rodrigues Jennifer,
Beemireddy Krishna,
Lewis–Jones Huw,
Hanlon Rebecca,
Husband David,
Shenoy Aditya,
Roland Nicholas J.,
Jackson Shaun R.,
Bekiroglu Fazilet,
Tandon Sankalap,
Lancaster Jeffrey,
Jones Terence M.
Publication year - 2016
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24432
Subject(s) - medicine , transoral laser microsurgery , soft palate , tonsil , head and neck cancer , chemoradiotherapy , oncology , stage (stratigraphy) , head and neck squamous cell carcinoma , tongue , cancer , radiation therapy , surgery , pathology , paleontology , biology
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. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263–1270, 2016