Robotic Surgical procedure Might Obviate Want for Chemotherapy in HPV-Related Throat Most cancers


NEW YORK (Reuters Well being) – In chosen older sufferers with human papillomavirus-associated oropharyngeal most cancers, transoral robotic surgical procedure (TORS) can increase survival and avert the necessity for chemotherapy, researchers present in a single-center examine.

“Though TORS has gained widespread adoption as a surgical approach, choosing which sufferers can profit probably the most from TORS has been a transferring goal,” Dr. Robert Brody of Penn Medication in Philadelphia informed Reuters Well being by electronic mail. “Whereas older sufferers could attempt to keep away from surgical procedure when potential, radiotherapy and chemotherapy have been proven to be extra poisonous in older populations.”

“Clinicians caring for older sufferers recognized with oropharyngeal most cancers ought to know that TORS in rigorously chosen sufferers can lead to glorious outcomes, much like these in youthful sufferers,” he mentioned. “Furthermore, …higher than one-third of sufferers have been in a position to bear surgical procedure alone with out the unwanted effects of radiation or chemotherapy.”

“Many sufferers who obtained post-operative radiotherapy got decreased doses of radiation,” he added, “thus limiting the prices and unwanted effects related to remedy.”

In JAMA Otolaryngology-Head and Neck Surgical procedure, Dr. Brody and colleagues report on 77 HPV-associated oropharyngeal most cancers sufferers handled from 2010-2017. The median age at prognosis was 73, and 75% have been males. The median follow-up was 39.6 months.

Perioperative mortality was 1.3% (one dying inside 30 days of surgical procedure) and the speed of oropharyngeal hemorrhage was 2.6%.

Thirty-nine % of sufferers averted all adjuvant remedy, as Dr. Brody famous, whereas 74% averted chemotherapy. Particularly, 27 sufferers (35.1%) underwent postoperative radiotherapy and 20 (26%) had postoperative chemoradiotherapy.

Three-year survival estimates have been 92.4% for disease-specific survival (DSS), 90% for general survival (OS), and 84.3% for disease-free survival (DFS).

On univariate evaluation, OS was negatively impacted by growing age (hazard ratio, 1.18); nevertheless, DFS and DSS weren’t. Nonetheless, DFS (HR, 5.27) and DSS (HR, 6.99) have been decrease in sufferers with stage II versus stage I illness and different detrimental pathologic indicators (lymphovascular invasion, perineural invasion, and extranodal extension).

Multivariable analyses couldn’t be carried out as a result of the occasions of curiosity have been too rare to succeed in minimal statistical thresholds.

Relating to limitations, the authors be aware that along with the retrospective/observational design of the examine, “our cohort underwent TORS, neck dissection, and adjuvant remedy as indicated at a excessive quantity and skilled heart and there was no comparative typical radiation remedy cohort, which can restrict the generalizability of this examine.”

Dr. Thomas Gernon, a head and neck surgeon at Metropolis of Hope in Duarte, California, commented in an electronic mail to Reuters Well being, “This strategy is certainly useful to any affected person inhabitants. Transoral robotic surgical procedure presents the potential of remedy de-escalation and might supply a possible treatment with out the necessity for the potential unwanted effects of chemotherapy and radiation.”

That mentioned, he famous, “Not all oropharynx tumors are candidates for transoral robotic surgical procedure,” and sufferers needs to be evaluated at main most cancers facilities by head and neck surgeons with fellowship coaching in transoral robotic surgical procedure.

“Very superior tumors that will probably be technically troublesome to take away or that may functionally go away the affected person in poor situation will not be candidates for surgical resection,” he mentioned.

SOURCE: JAMA Otolaryngology-Head and Neck Surgical procedure, on-line October 29, 2020.