Transoral laser microsurgery for oropharyngeal squamous cell carcinoma: A paradigm shift in therapeutic approach

• Published in: Head & neck Vol. 38; no. 8; pp. 1263 - 1270
• Main Authors: Wilkie, Mark D., Upile, Navdeep S., Lau, Andrew S., Williams, Stephen P., Sheard, Jon, Helliwell, Tim R., Robinson, Max, Rodrigues, Jennifer, Beemireddy, Krishna, Lewis-Jones, Huw, Hanlon, Rebecca, Husband, David, Shenoy, Aditya, Roland, Nicholas J., Jackson, Shaun R., Bekiroglu, Fazilet, Tandon, Sankalap, Lancaster, Jeffrey, Jones, Terence M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.08.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; carcinoma; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Chemoradiotherapy, Adjuvant; Cohort Studies; Disease-Free Survival; Female; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Human papillomavirus; Humans; Kaplan-Meier Estimate; Laser Therapy - methods; Laser Therapy - mortality; local; Male; Microsurgery - methods; Microsurgery - mortality; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Natural Orifice Endoscopic Surgery - methods; neoplasm recurrence; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - physiopathology; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - surgery; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Squamous Cell Carcinoma of Head and Neck; squamous cell/surgery; Survival Analysis; Treatment Outcome; United Kingdom; United Kingdom; laser therapy/methods; survival analysis; carcinoma; neoplasm recurrence; oropharyngeal neoplasms/surgery; oropharyngeal neoplasms/mortality; local; squamous cell/surgery
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.24432

Background The contemporary treatment of oropharyngeal squamous cell carcinoma (SCC) is an area of debate. We report outcomes of a minimally invasive approach involving transoral laser microsurgery (TLM). Methods A consecutive series of patients (n = 153) undergoing primary TLM for oropharyngeal SCC from 2006 to 2013 was studied. Human papillomavirus (HPV) status was determined by p16 immunohistochemistry and high‐risk HPV DNA in situ hybridization. Survival analyses were evaluated using Kaplan–Meier statistics. Results Tumor subsites included tonsil (n = 94; 61.5%), tongue base (n = 38; 24.8%), and soft palate (n = 21; 13.7%), with the majority being American Joint Committee on Cancer (AJCC) stage III/IVa (n = 124; 81.0%) and HPV‐positive (n = 101; 66.0%). Three‐year overall survival (OS), disease‐specific survival (DSS), and disease‐free survival (DFS) were 84.5%, 91.7%, and 78.2%, respectively. HPV‐positivity portended favorable oncologic outcomes. One‐year gastrostomy tube (G‐tube) dependency was 1.3%. Conclusion To the best of our knowledge, this is the largest single‐center TLM oropharyngeal SCC series to date. Our data suggest that TLM +/− postoperative radiotherapy (PORT) results in at least as good oncologic outcomes as chemoradiotherapy (CRT), while conferring swallowing function advantages. © 2016 Wiley Periodicals, Inc. Head Neck , 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:1263–1270, 2016