Transoral Robotic Surgery for SCC Improves Outcomes, Including in Smokers

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(ChemotherapyAdvisor) – Using transoral robotic surgery (TORS) to remove squamous cell carcinoma (SCC) of the oropharynx results in a significant improvement in outcomes, including among smokers, whose prognosis historically been poor, a retrospective study presented at the 8th International Conference on Head and Neck Cancer, Toronto, Ontario, Canada, July 21-25, has found.

A total of 57 treatment-naïve patients, 35 smokers and 22 nonsmokers, underwent prospective TORS with or without neck dissection followed by adjuvant therapy, reported Chaz L. Stucken, MD, of the Mount Sinai School of Medicine, New York, NY. Demographics were similar between the two groups; however, mean age was 63.3 years in the smoking group and 52.6 in the nonsmoking group (P=0.02).

At a mean follow-up of 19.9 months, preliminary 2-years outcomes data showed locoregional “control rates of 94% and 96% (P=0.64), distant metastasis control rates of 97% and 100% (P=0.38), progression-free survival of 91% and 96% (P=0.38), and overall survival of 97% and 100% (P=0.41) in the smoking and non-smoking groups, respectively,” Dr. Stucken noted.

“…our data supports the use of TORS as the primary modality of treatment for this high-risk population,” he said. “In addition to providing useful pathologic information to guide a personalized adjuvant therapy plan, TORS reduces tumor burden and appears to demonstrate excellent early oncologic outcomes regardless of smoking status.”

In a second study from Mount Sinai School of Medicine reported at the conference, John R. de Almeida, MD MSc, described the largest collection of oncologic outcomes following TORS in 233 patients, 191 male, with a mean age of 60.1 years, treated at 5 US institutions. Tumor sites at presentation were the tonsil (52.6 %), tongue base (36.2 %), pharyngeal walls (7.3 %), and palate (3.9%); most cancers were early T-stage and 78.6% were Stage III/IV.

“Negative margins were achieved in 89.5 % of patients and 87.7 % of patients underwent neck dissections,” Dr. de Almeida reported. TORS alone was performed in 34.8 % of patients; 29.6 % underwent adjuvant radiotherapy, and 35.6 %, adjuvant chemoradiotherapy. The 2-year locoregional control was 95.1%; metastasis-free survival was 97.4%; and overall survival, 95.8%. A total of 11 patients (4.7%) had local disease recurrence and 6 (2.6%) had distant metastases. Three patients died of their disease (1.3%), as did 6 others (2.6%) due to nondisease-related causes.

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