Journal article
Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy
JAMA otolaryngology-- head & neck surgery, Vol.142(7), pp.691-697
07/01/2016
DOI: 10.1001/jamaoto.2016.1106
PMCID: PMC6167603
PMID: 27347780
Abstract
Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited.
To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy.
This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015.
Disease-free survival, overall survival, and gastrostomy tube prevalence.
One hundred twenty-seven patients met the study criteria (113 men [89.0%]; 14 women [11.0%]; median [interquartile range] age, 57 [52-63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04-1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27-0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27-0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group: 3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at 3 months to 7 of 66 [11%] at 12 months).
Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.
Details
- Title: Subtitle
- Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy
- Creators
- Arun Sharma - Southern Illinois University School of MedicineSapna Patel - University of WashingtonFred M Baik - University of WashingtonGrant Mathison - University of MinnesotaBrendan H G Pierce - University of MinnesotaSamir S Khariwala - University of MinnesotaBevan Yueh - University of MinnesotaStephen M Schwartz - Fred Hutch Cancer CenterEduardo Méndez - Fred Hutch Cancer Center
- Resource Type
- Journal article
- Publication Details
- JAMA otolaryngology-- head & neck surgery, Vol.142(7), pp.691-697
- DOI
- 10.1001/jamaoto.2016.1106
- PMID
- 27347780
- PMCID
- PMC6167603
- NLM abbreviation
- JAMA Otolaryngol Head Neck Surg
- ISSN
- 2168-6181
- eISSN
- 2168-619X
- Grant note
- T32 DC000018 / NIDCD NIH HHS
- Language
- English
- Date published
- 07/01/2016
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984966754602771
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