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Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers

  • HEAD & NECK: Oral Cavity and Oropharyngeal Cancer (W Lydiatt, Section Editor)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Oropharyngeal cancer (OPC) has traditionally been managed by radiotherapy (RT)-based approaches. Minimally invasive surgery [transoral robotic surgery (TORS)/transoral laser microsurgery (TLMS)] is gaining popularity in T1-T2 HPV+ OPC. However, there is lack of high level evidence to guide practice. We summarize ongoing research regarding outcomes and investigational strategies for TORS/TLM- and RT-based treatments for this disease.

Recent Findings

Literature published in 2012–2017 demonstrated comparable exemplary outcomes with TORS/TLM and IMRT for selected HPV+ T1-T2 OPC. However, many TORS/TLM-treated patients also require adjuvant treatment, which impacts quality of life. Emerging RT-based de-intensification trial data suggest promising results. Ongoing investigation include indications for postoperative (chemo-)radiotherapy following TORS/TLM- and optimal RT-based de-intensification strategies.

Summary

A contemporary literature review demonstrates equal efficacy for TORS/TLM and IMRT as primary treatment for selected HPV+ T1-T2 OPC. TORS/TLM is an attractive approach when the opportunity for single modality treatment is high.

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Acknowledgements

We acknowledge the Bartley-Smith/Wharton, the Gordon Tozer, the Wharton Head and Neck Translational, Dr. Mariano Elia, and Petersen-Turofsky Funds, and “The Joe & Cara Finley Center for Head & Neck Cancer Research” at the Princess Margaret Cancer Foundation for supporting the authors’ (KR, BOS, SHH) academic activities. We also acknowledge the O. Harold Warwick Prize of the Canadian Cancer Society for supporting the author’s (BOS) academic activities. Finally, we acknowledge the Sanming Project of Medicine in Shenzhen Fund (SZSM201612024) for supporting the authors’ (BOS, SHH, ZC, ZX, JL) academic activities.

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  1. Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    Kathy Rock, Brian O’Sullivan & Shao Hui Huang

  2. Department of Radiation Oncology, Cork University Hospital, Cork, Ireland

    Kathy Rock

  3. Department of Clinical Oncology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, China

    Brian O’Sullivan, Zhi-Jian Chen, Zhi-Yuan Xu & Ji-Shi Li

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  1. Kathy Rock
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Correspondence to Zhi-Jian Chen or Shao Hui Huang.

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Rock, K., O’Sullivan, B., Chen, ZJ. et al. Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers. Curr Otorhinolaryngol Rep 6, 298–309 (2018). https://doi.org/10.1007/s40136-018-0214-4

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