Days alive and out of hospital after treatment for oropharyngeal squamous cell carcinoma with primary transoral robotic surgery or radiotherapy - a prospective cohort study
Authors: Scott, Susanne Irene; Madsen, Anne Kathrine Ostergaard; Rubek, Niclas; Kehlet, Henrik; von Buchwald, Christian
Background With the rising incidence of oropharyngeal squamous cell cancer, there is a need to assess the burden of treatment. Aims/objectives This study assessed 'days alive and out of hospital' (DAOH) in a cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with either transoral robotic surgery (TORS) or radiotherapy (RT). Material and methods A prospective cohort study conducted between May 2017-June 2019. Primary outcome was DAOH in the first 30 days after treatment (DAOH(30)). The secondary outcome was DAOH(180). Results Forty-four patients were included, 31 treated with TORS and 13 with RT. Patients treated with TORS had a median DAOH(30) of 25 (IQR 22.8-26) including a required four-day postoperative stay- and a median DAOH(180) of 168 (IQR 163-171.3). In contrast, patients treated with RT had a median DAOH(30) of 30 (IQR 26-30) and a DAOH(180) of 143 days (IQR 135.5-149). Conclusions and Significance DAOH has not been examined in oropharyngeal cancer before. We found, patients overall spent 92.5% of the first 180 days alive and out of hospital. Patients treated with TORS had high DAOH(30), which remained high in DAOH(180), while patients treated with RT with reduced DAOH(30), had reduced DAOH(180) calling for further large-scale studies.
Transoral robotic surgery and neck dissection for HPV-positive oropharyngeal carcinoma: Importance of nodal count in survival
Authors: Viet, Chi T.; Dierks, Eric J.; Cheng, Allen C.; Patel, Ashish A.; Chang, Shu-Ching; Couey, Marcus A.; Watters, Amber L.; Thien Hoang; Xiao, Hong D.; Crittenden, Marka R.; Leidner, Rom S.; Seung, Steven K.; Young, Kristina H.; Bell, R. Bryan
Background: In this study we determine the survival in patients with HPV-positive oropharyngeal carcinoma treated with transoral robotic surgery (TORS), neck dissection and risk-adapted adjuvant therapy. Methods: We retrospectively identified 122 patients with HPV-positive oropharyngeal carcinoma treated with TORS and neck dissection between 2011 and 2018. Survival probability was calculated. We determined the effect of the type of neck dissection performed (modified radical neck dissection-MRND vs. selective neck dissection - SND), extranodal extension (ENE), margin status, and presence of >= 5 metastatic nodes on survival. Results: Our patient population had a five-year overall survival of 91.0% (95% C.I. 85-97%). The five-year probability of recurrence or cancer-associated death was 0.0977 (95% C.I. 0.0927-0.1027). The five-year probability of cancer-associated death was 0.0528 (95% C.I. 0.048-0.0570). All patients who died of their disease had distant metastasis. Our PEG dependence rate was 0%. Patients with ENE and positive margins who underwent adjuvant chemoradiation did not have worse survival. Presence of >= 5 metastatic nodes portended worse survival after controlling for age, positive ENE and margins. Low yield (< 18 nodes) on neck dissection worsened DFS on multivariable analysis. Furthermore, patients who underwent SND did not have worse OS than those who underwent MRND. Conclusion: Our study demonstrates that surgery could be simplified by performing TORS with SND rather than MRND. The one true poor prognostic factor in HPV-positive oropharyngeal carcinoma patients who undergo surgery is high nodal burden. Patients with high nodal burden are much more likely to die from their disease.