Transoral Laser Microsurgery (TLM) Followed by Radiation Therapy (RT) for Oropharyngeal Tumors

Abstract

Purpose/Objective(s)To report the treatment outcomes of locally advanced oropharyngeal cancer patients (pts) treated with TLM followed by RT at MCA.Materials/MethodsAn IRB approved retrospective study of 80 pts treated from January 1, 2000 through November 7, 2011 was performed. All pts had stage III or IV tonsil and/or base of tongue primary tumors and underwent TLM with neck dissection. Adjuvant radiation therapy was given after TLM. Thirty seven (46%) pts received concurrent adjuvant cisplatin or cetuximab chemotherapy . The primary outcome measured was locoregional control.ResultsMedian follow up was 32.9 months (range 6.5-117.6). The median radiation dose was 60 Gy (range 50-70 Gy). The 3-year locoregional control, recurrence free survival, and overall survival rates were 98.3% (95% CI 88-100%), 90% (95% CI 79-95%), and 93% (95% CI 82-97%), respectively. There were a total of 11 deaths and 5 treatment failures, 1 regional and 4 distant. Thirty three percent of the pts underwent neck only radiation therapy with exclusion of the primary site and had no locoregional recurrences. Twenty five percent of pts had grade 3 dysphagia during RT and 6.3% of pts required use of a PEG tube at 1 year.ConclusionsTLM followed by RT for locally advanced oropharyngeal cancer results in very promising locoregional control rates. A prospective study examining patient reported outcomes and the exclusion of the primary site in the radiation field is being planned. Purpose/Objective(s)To report the treatment outcomes of locally advanced oropharyngeal cancer patients (pts) treated with TLM followed by RT at MCA. To report the treatment outcomes of locally advanced oropharyngeal cancer patients (pts) treated with TLM followed by RT at MCA. Materials/MethodsAn IRB approved retrospective study of 80 pts treated from January 1, 2000 through November 7, 2011 was performed. All pts had stage III or IV tonsil and/or base of tongue primary tumors and underwent TLM with neck dissection. Adjuvant radiation therapy was given after TLM. Thirty seven (46%) pts received concurrent adjuvant cisplatin or cetuximab chemotherapy . The primary outcome measured was locoregional control. An IRB approved retrospective study of 80 pts treated from January 1, 2000 through November 7, 2011 was performed. All pts had stage III or IV tonsil and/or base of tongue primary tumors and underwent TLM with neck dissection. Adjuvant radiation therapy was given after TLM. Thirty seven (46%) pts received concurrent adjuvant cisplatin or cetuximab chemotherapy . The primary outcome measured was locoregional control. ResultsMedian follow up was 32.9 months (range 6.5-117.6). The median radiation dose was 60 Gy (range 50-70 Gy). The 3-year locoregional control, recurrence free survival, and overall survival rates were 98.3% (95% CI 88-100%), 90% (95% CI 79-95%), and 93% (95% CI 82-97%), respectively. There were a total of 11 deaths and 5 treatment failures, 1 regional and 4 distant. Thirty three percent of the pts underwent neck only radiation therapy with exclusion of the primary site and had no locoregional recurrences. Twenty five percent of pts had grade 3 dysphagia during RT and 6.3% of pts required use of a PEG tube at 1 year. Median follow up was 32.9 months (range 6.5-117.6). The median radiation dose was 60 Gy (range 50-70 Gy). The 3-year locoregional control, recurrence free survival, and overall survival rates were 98.3% (95% CI 88-100%), 90% (95% CI 79-95%), and 93% (95% CI 82-97%), respectively. There were a total of 11 deaths and 5 treatment failures, 1 regional and 4 distant. Thirty three percent of the pts underwent neck only radiation therapy with exclusion of the primary site and had no locoregional recurrences. Twenty five percent of pts had grade 3 dysphagia during RT and 6.3% of pts required use of a PEG tube at 1 year. ConclusionsTLM followed by RT for locally advanced oropharyngeal cancer results in very promising locoregional control rates. A prospective study examining patient reported outcomes and the exclusion of the primary site in the radiation field is being planned. TLM followed by RT for locally advanced oropharyngeal cancer results in very promising locoregional control rates. A prospective study examining patient reported outcomes and the exclusion of the primary site in the radiation field is being planned.