Transoral robotic surgery (TORS) should be considered the preferred surgical treatment for head and neck cancers in the salvage setting, according to researchers.

The researchers found that TORS yielded “favorable outcomes” for patients with residual, recurrent, and new primary head and neck cancers in previously irradiated fields.

These results were published in the Journal of the National Cancer Institute


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The study included 278 adults with a history of head and neck cancer previously treated with chemoradiotherapy who experienced a residual, recurrent, or new primary head and neck cancer that was treated with TORS. 

Patients underwent surgery at 16 high-volume international centers before August 2018. Most of the patients had oropharyngeal cancers (93.8%). The median age was 61 years, and 20.1% were women. 

The median time since completion of treatment for previous head and neck cancer was 761.5 days. The median follow-up was 28.5 months.

The rate of local control was 69.0% at 2 years and 62.2% at 5 years. The disease-free survival rate was 47.2% at 2 years and 35.7% at 5 years. The overall survival rate was 71.8% at 2 years and 49.8% at 5 years. 

According to the researchers, the overall survival outcomes compare “favorably to alternative treatments that may be considered for these patients, including re-irradiation and open surgery.” 

Increasing age, current smoking, primary tumor classification, and narrow surgical margin were all associated with inferior overall survival in this study. 

The researchers also assessed the most discriminating margin cut point and identified it as 1.0 mm. The 2-year local control rate was 80.9% when the margin was greater than 1.0 mm and 54.2% when the margin was below or equal to 1.0 mm. 

“It is important to stress that the authors are not recommending that surgeons should aim for more than 1.0 mm minimum resection margins as routine practice for recurrent cancer TORS; surgeons should continue to strive for higher minimum margins where safely feasible and appropriate,” the researchers wrote. “However, the results presented here indicate that favorable outcomes can be achieved even when minimum margins are reported as being more than 1.0 mm.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Hardman JC, Holsinger FC, Brady GC, et al. Transoral robotic surgery for recurrent tumors of the upper aerodigestive tract (RECUT): An international cohort study. J Natl Cancer Inst. Published online August 10, 2022. doi:10.1093/jnci/djac130