Abstract
ObjectiveThe optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas.MethodsAll patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM.ResultsBetween 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72 %) patients had primary carcinoma, nine (23 %) were radiation/chemoradiation (RT/CRT) failures, and two (5 %) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88 %) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5 % (SE 10.6 %), 85.7 % (SE 13.2 %) and 77.7 % (SE 12.5 %) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76 % (SE 15.7 %) for LC and 55.6 % (SE 16.6 %) for DSS and DFS. Three patients developed complications following surgery.ConclusionsObserved 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.
Highlights
The incidence of oropharyngeal squamous cell carcinoma (OSCC) has been increasing, largely because of increasing rates of Human Papilloma Virus (HPV) infection [1,2,3,4]. This is an important trend clinically as HPV positive OSCC is associated with a better prognosis and treatment outcome [5, 6]
Contraindications to transoral laser microsurgery (TLM) include inadequate access to the primary site, large vessel proximity or Melong et al Journal of Otolaryngology - Head and Neck Surgery (2015) 44:39 involvement, and oncologic contraindications including T4b cancers, unresectable neck disease or multiple distant metastases [13, 14]
The purpose of this study was to evaluate the oncologic measures of TLM for OSCC at our center, adding to the growing evidence of support for the use of TLM as a first line treatment modality for these carcinomas. This was a prospective, cohort study based on a database monitoring all malignancies treated with TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia
Summary
The incidence of oropharyngeal squamous cell carcinoma (OSCC) has been increasing, largely because of increasing rates of Human Papilloma Virus (HPV) infection [1,2,3,4]. Contraindications to TLM include inadequate access to the primary site (e.g. trismus, large tongue base, prominent dentition, etc.), large vessel proximity or Melong et al Journal of Otolaryngology - Head and Neck Surgery (2015) 44:39 involvement (e.g. tumour adjacent to the carotid bulb or internal carotid, deep bilateral base of tongue invasion increasing the risk of damage to both lingual arteries, etc.), and oncologic contraindications including T4b cancers, unresectable neck disease or multiple distant metastases [13, 14] Despite these limitations, TLM offers potential advantages over open surgery including shorter recovery time, fewer complications and better functional outcomes [15,16,17]. Surgical intervention offers the advantage of pathologic characterization of the tumour, helping to guide further management and treatment, an advantage that is not readily available with RT/CRT
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