Head and neck
Published: 2022-08-08
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Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer center

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0001-8783-0493
Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0003-4813-1475
Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0002-7879-4846
Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0003-4981-1851
Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0002-5757-6073
Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0003-0498-2964
Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0002-5339-8038
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Treatment, IEO European Institute of Oncology IRCCS, Milan, Italy
Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
https://orcid.org/0000-0002-1348-4548
Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
Department of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy; * D. Alterio and M. Ansarin are co-last authors.
https://orcid.org/0000-0003-1086-0736
Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy;* D. Alterio and M. Ansarin are co-last authors.
https://orcid.org/0000-0002-8384-5388
oropharyngeal cancer HPV transoral robotic surgery (TORS) intensitymodulated radiotherapy (IMRT) minimally invasive surgery

Abstract

Objective. This study aims to provide real-world data on oncologic and functional outcomes of the most modern surgical and non-surgical treatments of locally advanced HPVpositive oropharyngeal cancer.
Methods. We reviewed data on patients treated for stage III and IV HPV-positive oropharyngeal squamous cell carcinoma with either endoscopic surgery (Transoral Robotic Surgery, TORS; Transoral Laser Microsurgery, TLM – group A) or intensity-modulated radiotherapy (IMRT – group B). The minimum follow-up required was 6 months. Survival outcomes and toxicities of treatments were evaluated.
Results. 30 patients in group A and 66 in group B were eligible for the analysis. 28% of patients in group A underwent a unimodal treatment, while 42% needed trimodal treatment. 90% of patients in group B underwent concurrent chemoradiation. We found no statistically significant difference in survival outcomes (group A: overall survival 97%, progression-free survival 83%; group B: OS 98%, PFS 86%) or toxicities between groups. Conclusions. Both transoral surgery and IMRT provide excellent outcomes in HPV-positive oropharyngeal cancer. Because of the good prognosis, treatments need to be refined to reduce toxicities while preserving oncologic soundness.

Affiliations

Stefano Filippo Zorzi

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy

Giovanni Agostini

Section of Otolaryngology-Head and Neck Surgery, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy

Francesco Chu

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy

Marta Tagliabue

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy

Giacomo Pietrobon

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy

Giulia Corrao

Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy

Stefania Volpe

Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy

Giulia Marvaso

Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy

Francesca Colombo

Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

Maria Cossu Rocca

Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Treatment, IEO European Institute of Oncology IRCCS, Milan, Italy

Sara Gandini

Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy

Aurora Gaeta

Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy

Francesca Ruju

Department of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy

Daniela Alterio

Department of Radiotherapy and Adrotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy; * D. Alterio and M. Ansarin are co-last authors.

Mohssen Ansarin

Department of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy;* D. Alterio and M. Ansarin are co-last authors.

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2022

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