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Transoral Robotic Surgery, Intensity-Modulated Radiotherapy Offer Comparable Survival Estimates for Early T-Stage Oropharyngeal Cancer

by Amy Eckner • September 7, 2014

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Clinical Question

How do survival estimates for transoral robotic surgery (TORS) compare to intensity-modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer?

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Explore This Issue
September 2014

Background: There have been concerns regarding the effectiveness of TORS as a treatment for early T-stage oropharyngeal carcinoma compared to existing treatment. Newer nonsurgical techniques have improved on traditional three-dimensional conformal radiotherapy by limiting the toxicity burden while offering similar disease control. One challenge in interpreting the literature is the patient heterogeneity reported.

Study design: Retrospective study of 20 cases reported through September 2012, including patients treated for early T-stage oropharynx cancer with TORS or IMRT.

Setting: MEDLINE, EMBASE, CENTRAL, PsychINFO, CINAHL, and bibliographies of relevant studies.

Synopsis: For early T-stage tumors, 350 of 794 patients received chemotherapy in addition to IMRT. Three studies reported that 57 of 152 patients (38%) received neck dissections for possible residual disease following treatment. The incidence of N2c or N3 metastases was always less than 16% among TORS studies and less than 17% among IMRT studies. All TORS patients were treated with transoral robotic resection of an oropharyngeal primary cancer. IMRT studies reported a two-year disease-specific survival ranging from 82% to 97.7%. TORS studies reported a two-year disease-specific survival ranging from 79% to 98%. Five IMRT studies reported adverse event outcomes, including osteoradionecrosis of the mandible (2.6%) and esophageal stenosis (4.8%). Nine TORS studies reported adverse event outcomes, including post-operative bleeding (2.4%), neck hematomas (0.4%), and a cumulative pharyngocutaneous fistula rate of 2.5%. Limitations included a lack of meta-analysis and patient-reported subjective outcomes due to the retrospective, heterogeneous, and noncomparative nature of the studies.

Bottom line: Survival estimates are similar for TORS and IMRT; the differences lie in adverse events and are likely based on the specifics of their toxicity and complication profiles.

Citation: De Almeida JR, Byrd JK, Wu R, et. al. A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope. 2014;124:2096-2102.

—Reviewed by Amy Eckner

Filed Under: Head and Neck, Head and Neck, Literature Reviews, Practice Focus Tagged With: carcinoma, IMRT, TORSIssue: September 2014

You Might Also Like:

  • Cost Analysis of Transoral Surgery versus XRT for Early-Stage Glottic Cancer
  • Larynx-Preserving Surgery Associated with Improved Survival in Early-Stage Glottic Cancer
  • TORS Use in Early Stage Oropharyngeal Cancer May Lower Positive Margin Outcome
  • Transoral Robotic Surgery Newest Treatment Option for Oropharyngeal Cancers

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