TORS ‘viable’ and preserves QoL in oropharyngeal cancer
By Joanna Lyford, Senior medwireNews Reporter
21 August 2013
JAMA Otolaryngol Head Neck Surg 2013; Advance online publication

medwireNews: Patients with oropharyngeal squamous cell carcinoma (OPSCC) who are treated with transoral robotic surgery (TORS) maintain a high quality of life (QoL) at 1-year post-surgery, a prospective study indicates.

The finding is important because conventional management strategies – namely, external-beam radiation therapy (XRT) or chemoradiation therapy (CRT) – are associated with significant toxicity and poor functional and psychosocial outcomes, say the study researchers.

“These results suggest that TORS is a viable alternative to primary CRT in OPSCC treatment,” write Peter Dziegielewski (The Ohio State University Wexner Medical Center, Columbus, USA) and co-authors in JAMA Otolaryngology Head & Neck Surgery.

The researchers studied 81 patients with previously untreated T1–T4 OPSCC who underwent primary surgical resection with TORS. The extent of resection was determined by the number of significantly involved sites, and patients with high-risk features received adjuvant treatment, including XRT or CRT, within 6 weeks.

No patient died within 30 days of surgery and all patients were discharged home on a full oral diet; the proportion of patients needing a gastrostomy tube was 24% at 6 months and 9% at 12 months.

Health-related QoL was determined using the Head and Neck Cancer Inventory (HNCI), which assesses functional and attitudinal ability in four domains: speech, eating, social disruption, and aesthetics.

The mean duration of follow-up was 22.7 months. Dziegielewski et al report that mean scores in all four domains of the HNCI declined in the early postoperative period and reached a nadir at around 3 months post-surgery.

Subsequently, however, HNCI scores increased in all domains and by 1-year post-surgery were approaching preoperative levels for the aesthetic and social domains and for overall QoL.

Logistic regression analysis found that radiation therapy was significantly negatively correlated with all QoL domains while patient age younger than 55 years correlated with lower speech and aesthetic scores. Additionally, resection of more than one oropharyngeal site and age older than 55 years predicted the need for a gastrostomy tube after TORS.

The authors conclude that while TORS helps patients with OPSCC to maintain a high QoL after surgery, older patients and those needing adjuvant treatment have a lower QoL and “should be counseled appropriately.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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