nach oben

European Archives of Oto-Rhino-Laryngology

Erschienen in:

21.07.2020 | Review Article

Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis

verfasst von: Armando De Virgilio, Andrea Costantino, Giuseppe Mercante, Raul Pellini, Fabio Ferreli, Luca Malvezzi, Giovanni Colombo, Giovanni Cugini, Gerardo Petruzzi, Giuseppe Spriano

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To perform a meta-analysis evaluating trans-oral robotic surgery (TORS), and intensity-modulated radiation therapy (IMRT) in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).

Methods

This study adhered to the PRISMA guidelines.

Results

A total of 5624 patients (IMRT, n = 4322; TORS, n = 1302) were included in this meta-analysis. The majority of patients in the IMRT cohort were treated with concurrent CT (n = 3433, 81.3%). On the other hand, the majority of patients in the TORS cohort was treated with an adjuvant treatment (n = 826, 67.8%). IMRT subgroup showed a cumulative survival rate of 83.6% (99% CI 76.9–89.3%), while it was 91.3% (99% CI 81.2–97.8%) in the TORS subgroup. Disease-free survival was significantly different between IMRT (79.6%, 99% CI 70.6–87.3%), and TORS (89.4%, 99% CI 82.7–94.5%). IMRT subgroup showed a feeding tube dependence rate of 4.0% (99% CI 1.1–8.4%), but it was not significantly different from the TORS subgroup (1.3%, 99% CI 0–4.9%). Tracheostomy dependence rates were similar among the two subgroups (IMRT, 0.7%, 99% CI 0–1.1%; TORS, 0.2%, 99% CI 0–1.1%).

Conclusions

TORS appears to be a consolidated effective surgical approach in the management of OPSCC, according to both oncologic and functional outcomes. Further RCTs comparing TORS and IMRT with homogeneous cohorts in terms of tumor staging and HPV status are advisable.

Mehanna H, Beech T, Nicholson T et al (2013) Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer—systematic review and meta-analysis of trends by time and region. Head Neck 35(5):747–755PubMed

Marur S, D’Souza G, Westra WH, Forastiere AA (2010) HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol 11(8):781–789PubMedPubMedCentral

Castellsagué X, Alemany L, Quer M et al (2016) HPV involvement in head and neck cancers: comprehensive assessment of biomarkers in 3680 patients. J Natl Cancer Inst 108(6):djv403PubMed

National Comprehensive Cancer Network (2019) Head and neck cancers (version 3.2019). https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 29 Jan 2020

Ang KK, Harris J, Wheeler R et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363(1):24–35PubMedPubMedCentral

Licitra L, Perrone F, Bossi P et al (2006) High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma. J Clin Oncol 24(36):5630–5636PubMed

Fakhry C, Westra WH, Li S et al (2008) Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 100(4):261–269PubMed

Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26(21):3582–3589PubMedPubMedCentral

Ford SE, Brandwein-Gensler M, Carroll WR, Rosenthal EL, Magnuson JS (2014) Transoral robotic versus open surgical approaches to oropharyngeal squamous cell carcinoma by human papillomavirus status. Otolaryngol Head Neck Surg 151(4):606–611PubMed

10.

White H, Ford S, Bush B et al (2013) Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches. JAMA Otolaryngol Head Neck Surg 139(8):773–778PubMed

11.

Mercante G, Masiello A, Sperduti I et al (2015) Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: a 1-year follow-up study. J Craniomaxillofac Surg 43(8):1561–1566PubMed

12.

Masterson L, Moualed D, Liu ZW et al (2014) De-escalation treatment protocols for human papillomavirus-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of current clinical trials. Eur J Cancer 50(15):2636–2648PubMed

13.

Mirghani H, Blanchard P (2018) Treatment de-escalation for HPV-driven oropharyngeal cancer: Where do we stand? Clin Transl Radiat Oncol 8:4–11PubMed

14.

Owadally W, Hurt C, Timmins H et al (2015) PATHOS: a phase II/III trial of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery for Human papillomavirus (HPV) positive oropharyngeal cancer. BMC Cancer 15:602PubMedPubMedCentral

15.

Siegel RS, Rafei H, Joshi A et al (2018) Phase II study: Induction chemotherapy and transoral surgery as definitive treatment (Tx) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC): a novel approach. J Clin Oncol 36(15_suppl):6004–6004

16.

Chao KS, Low DA, Perez CA, Purdy JA (2000) Intensity-modulated radiation therapy in head and neck cancers: the Mallinckrodt experience. Int J Cancer 90(2):92–103PubMed

17.

Marur S, Li S, Cmelak AJ et al (2017) E1308: phase II trial of induction chemotherapy followed by reduced-dose radiation and weekly cetuximab in patients with HPV-associated resectable squamous cell carcinoma of the oropharynx—ECOG-ACRIN Cancer Research Group. J Clin Oncol 35(5):490–497PubMed

18.

Misiukiewicz K, Gupta V, Miles BA et al (2019) Standard of care vs reduced-dose chemoradiation after induction chemotherapy in HPV+ oropharyngeal carcinoma patients: the Quarterback trial. OralOncol 95:170–177

19.

Fischer CA, Zlobec I, Green E et al (2010) Is the improved prognosis of p16 positive oropharyngeal squamous cell carcinoma dependent of the treatment modality? Int J Cancer 126(5):1256–1262PubMed

20.

Nichols AC, Theurer J, Prisman E et al (2019) Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol 20(10):1349–1359PubMed

21.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100PubMedPubMedCentral

22.

Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716PubMed

23.

Higgins JPT, Altman DG, Gøtzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentral

24.

Rousseau MJ, Evans JC (2017) Key statistical assumptions and methods in one-arm meta-analyses with binary endpoints and low event rates, including a real-life example in the area of endoscopic colonic stenting. Cogent Med 4(1):1334318

25.

Di Maio P, Iocca O, De Virgilio A et al (2019) Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: a systematic review and meta-analysis. Head Neck 41(4):1112–1121PubMed

26.

Veroniki AA, Jackson D, Viechtbauer W et al (2016) Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods 7(1):55–79PubMed

27.

Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2006) Comparison of two methods to detect publication bias in meta-analysis. JAMA 295(6):676–680PubMed

28.

Bird T, De Felice F, Michaelidou A et al (2017) Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma— a European single institution analysis. Clin Otolaryngol 42(1):115–122PubMed

29.

Blanchard P, Garden AS, Gunn GB et al (2016) Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer—a case matched analysis. Radiother Oncol 120(1):48–55PubMedPubMedCentral

30.

Broglie MA, Soltermann A, Rohrbach D et al (2013) Impact of p16, p53, smoking, and alcohol on survival in patients with oropharyngeal squamous cell carcinoma treated with primary intensity-modulated chemoradiation. Head Neck 35(12):1698–1706PubMed

31.

Burr AR, Harari PM, Ko HC et al (2019) Reducing radiotherapy target volume expansion for patients with HPV-associated oropharyngeal cancer. Oral Oncol 92:52–56PubMedPubMedCentral

32.

Chao KS, Majhail N, Huang CJ et al (2001) Intensity-modulated radiation therapy reduces late salivary toxicity without compromising tumor control in patients with oropharyngeal carcinoma: a comparison with conventional techniques. Radiother Oncol 61(3):275–280PubMed

33.

Chera BS, Amdur RJ, Tepper J et al (2015) Phase 2 trial of de-intensified chemoradiation therapy for favorable-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys 93(5):976–985PubMed

34.

Daly ME, Le Q-T, Maxim PG et al (2010) Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: clinical outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 76(5):1339–1346PubMed

35.

De Felice F, Galdieri A, Abate G et al (2017) Definitive intensity-modulated radiation therapy in elderly patients with locally advanced oropharyngeal cancer. Vivo 31(3):455–459

36.

Eisbruch A, Harris J, Garden AS et al (2010) Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys 76(5):1333–1338PubMed

37.

Feng FY, Kim HM, Lyden TH et al (2010) Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. J Clin Oncol 28(16):2732–2738PubMedPubMedCentral

38.

Garden AS, Morrison WH, Wong P-F et al (2007) Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 67(2):438–444PubMed

39.

Garden AS, Dong L, Morrison WH et al (2013) Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 85(4):941–947PubMed

40.

Gillison ML, Trotti AM, Harris J et al (2019) Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 393(10166):40–50PubMed

41.

Huang K, Xia P, Chuang C et al (2008) Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: the University of California-San Francisco experience. Cancer 113(3):497–507PubMed

42.

Hunter KU, Schipper M, Feng FY et al (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85(4):935–940PubMed

43.

Ingle CJ, Yip K, Caskie V et al (2010) Intensity modulated radiotherapy (IMRT) in the management of locally advanced oropharyngeal squamous cell carcinomata (SCC): disease control and functional outcome using the therapy outcome measure (TOM) score—report from a single UK institution. Head Neck Oncol 2:28PubMedPubMedCentral

44.

Kanakamedala MR, Giri SPG, Hamilton RD, Bhanat E, Vijayakumar S (2018) Outcomes utilizing intensity-modulated radiotherapy in oropharyngeal cancers: tonsils versus base of tongue. Head Neck 40(5):1034–1039PubMedPubMedCentral

45.

Lohia S, Rajapurkar M, Nguyen SA et al (2014) A comparison of outcomes using intensity-modulated radiation therapy and 3-dimensional conformal radiation therapy in treatment of oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg 140(4):331–337PubMed

46.

Matsuura T, Nishimura Y, Nakamatsu K et al (2017) Clinical outcomes of IMRT planned with or without PET/CT simulation for patients with pharyngeal cancers. Int J Clin Oncol 22(1):52–58PubMed

47.

May JT, Rao N, Sabater RD et al (2013) Intensity-modulated radiation therapy as primary treatment for oropharyngeal squamous cell carcinoma. Head Neck 35(12):1796–1800PubMed

48.

Mehanna H, Robinson M, Hartley A et al (2019) Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet 393(10166):51–60PubMedPubMedCentral

49.

Mendenhall WM, Amdur RJ, Morris CG, Kirwan JM, Li JG (2010) Intensity-modulated radiotherapy for oropharyngeal squamous cell carcinoma. Laryngoscope 120(11):2218–2222PubMed

50.

Nichols AC, Faquin WC, Westra WH et al (2009) HPV-16 infection predicts treatment outcome in oropharyngeal squamous cell carcinoma. Otolaryngol Head Neck Surg 140(2):228–234PubMed

51.

Saba NF, Edelman S, Tighiouart M et al (2009) Concurrent chemotherapy with intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the larynx and oropharynx: a retrospective single-institution analysis. Head Neck 31(11):1447–1455PubMed

52.

Setton J, Caria N, Romanyshyn J et al (2012) Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: an update of the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys 82(1):291–298PubMed

53.

Shoushtari A, Meeneghan M, Sheng K et al (2010) Intensity-modulated radiotherapy outcomes for oropharyngeal squamous cell carcinoma patients stratified by p16 status. Cancer 116(11):2645–2654PubMed

54.

Yao M, Nguyen T, Buatti JM et al (2006) Changing failure patterns in oropharyngeal squamous cell carcinoma treated with intensity modulated radiotherapy and implications for future research. Am J Clin Oncol 29(6):606–612PubMed

55.

Achim V, Bolognone RK, Palmer AD et al (2018) Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg 144(1):18–27PubMed

56.

Al-Khudari S, Bendix S, Lindholm J et al (2013) Gastrostomy tube use after transoral robotic surgery for oropharyngeal cancer. ISRN Otolaryngol 2013:190364PubMedPubMedCentral

57.

Blanco RGF, Fakhry C, Ha PK et al (2013) Transoral robotic surgery experience in 44 cases. J Laparoendosc Adv Surg Tech A 23(11):900–907PubMed

58.

Cannon RB, Houlton JJ, Patel S et al (2018) Patterns of cervical node positivity, regional failure rates, and fistula rates for HPV+ oropharyngeal squamous cell carcinoma treated with transoral robotic surgery (TORS). Oral Oncol 86:296–300PubMed

59.

Cohen MA, Weinstein GS, O’Malley BW, Feldman M, Quon H (2011) Transoral robotic surgery and human papillomavirus status: oncologic results. Head Neck 33(4):573–580PubMed

60.

Dabas S, Gupta K, Ranjan R et al (2017) Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): a prospective trial. Oral Oncol 69:80–83PubMed

61.

Dabas S, Gupta K, Sharma AK et al (2019) Oncological outcome following initiation of treatment for stage III and IV HPV negative oropharyngeal cancers with transoral robotic surgery (TORS). Eur J Surg Oncol 45(11):2137–2142PubMed

62.

Dean NR, Rosenthal EL, Carroll WR et al (2010) Robotic-assisted surgery for primary or recurrent oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 136(4):380–384PubMed

63.

Dhanireddy B, Burnett NP, Sanampudi S et al (2019) Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation. Am J Otolaryngol 40(5):673–677PubMed

64.

Dziegielewski PT, Teknos TN, Durmus K et al (2013) Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg 139(11):1099–1108PubMedPubMedCentral

65.

Lee SY, Park YM, Byeon HK, Choi EC, Kim S-H (2014) Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer. Head Neck 36(8):1138–1145PubMed

66.

Lörincz BB, Möckelmann N, Busch C-J, Knecht R (2015) Functional outcomes, feasibility, and safety of resection of transoral robotic surgery: single-institution series of 35 consecutive cases of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck 37(11):1618–1624PubMed

67.

Meccariello G, Montevecchi F, D’Agostino G et al (2019) Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. Acta Otorhinolaryngol Ital 39(2):75–83PubMedPubMedCentral

68.

Moore EJ, Van Abel KM, Price DL et al (2018) Transoral robotic surgery for oropharyngeal carcinoma: surgical margins and oncologic outcomes. Head Neck 40(4):747–755PubMed

69.

Olsen SM, Moore EJ, Laborde RR et al (2013) Transoral surgery alone for human-papillomavirus-associated oropharyngeal squamous cell carcinoma. Ear Nose Throat J 92(2):76–83PubMed

70.

Rubek N, Channir HI, Charabi BW et al (2017) Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. Eur Arch Otorhinolaryngol 274(5):2229–2237PubMed

71.

Weinstein GS, Quon H, Newman HJ et al (2012) Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg 138(7):628–634PubMed

72.

Smith RV, Schiff BA, Garg M, Haigentz M (2015) The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients. Laryngoscope 125(Suppl 10):S1–15PubMed

73.

De Virgilio A, Kim S-H, Magnuson JS et al (2019) Anatomical-based classification for transoral lateral oropharyngectomy. OralOncol 99:104450

74.

De Virgilio A, Costantino A, Mercante G et al (2020) Trans-oral robotic surgery in the management of parapharyngeal space tumors: a systematic review. Oral Oncol 103:104581PubMed

75.

De Virgilio A, Park YM, Kim WS, Baek SJ, Kim S-H (2013) How to optimize laryngeal and hypopharyngeal exposure in transoral robotic surgery. Auris Nasus Larynx 40(3):312–319PubMed

76.

de Almeida JR, Byrd JK, Wu R et al (2014) A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope 124(9):2096–2102PubMed

77.

Yeh DH, Tam S, Fung K et al (2015) Transoral robotic surgery vs radiotherapy for management of oropharyngeal squamous cell carcinoma—a systematic review of the literature. Eur J Surg Oncol 41(12):1603–1614PubMed

78.

Stelmes J-J, Gregoire V, Poorten VV et al (2019) Organ preservation and late functional outcome in oropharyngeal carcinoma: rationale of EORTC 1420, the “best of” trial. Front Oncol 9:999PubMedPubMedCentral

Titel: Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis
verfasst von: Armando De Virgilio
Andrea Costantino
Giuseppe Mercante
Raul Pellini
Fabio Ferreli
Luca Malvezzi
Giovanni Colombo
Giovanni Cugini
Gerardo Petruzzi
Giuseppe Spriano
Publikationsdatum: 21.07.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Archives of Oto-Rhino-Laryngology / Ausgabe 5/2021
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-06224-z

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis