To see long-term oncological outcome of Transoral Robotic Surgery for intensification of treatment in addition to adjuvant Radiotherapy/chemoradiotherapy for Stage IV HPV negative oropharyngeal malignancies.
From March 2013 to September 2015, 86 patients with Stage IV (cT1-3N2) HPV negative oropharyngeal carcinoma underwent TORS & neck dissection using
A total of 86 patients (69 males and 17 females) underwent TORS. All patients were HPV negative. Mean age at presentation was 57.4 years (32-83 years). Escalation of therapy with TORS followed by 60-64Gy ± 5-6 cycles weekly Inj. cisplatin adjuvant RT/CTRT lead to better survival rates as compared to CTRT/RT alone. T1-3N2a: 12 patients: All underwent TORS followed by RT in 7 patients and CTRT in 5 patients. Ten patients are disease free and alive on an average follow-up of 29 months with two patients developed nodal recurrence, but are alive after salvage surgery. T1-3N2b: 56 patients: After TORS, 40 patients received CTRT and 16 patients received only RT. 46 (82.1%) are alive and disease free. Six patients developed loco-regional recurrence of which 4 patients were salvaged and disease free. Four patients expired due to metastasis T1-3N2c: 18 patients: After TORS, 13 received adjuvant CTRT and 5 received RT. 10 (55.6%) were disease free and alive. Seven patients developed locoregional recurrence of which 4 are disease free and alive after salvage surgery. 3 patients expired due to disease. Of 86 patients with Stage IVa Oropharyngeal Carcinoma, escalation of treatment with TORS followed by adjuvant CTRT/RT gave disease free survival of 76.7% and an overall survival of 88.4% on a mean follow-up of 34 months (21-51 months).
Transoral Robotic Surgery is a good option for cure in relatively radio-resistant HPV negative resectable oropharyngeal malignancies. TORS can be used to intensify treatment of Stage IV oropharyngeal carcinoma and avoid early and late toxicities due to higher doses of RT/CRT and achieve better oncological outcome.
FMRI, Gurgaon
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All authors have declared no conflicts of interest.