Transoral laser surgery recommended for advanced oropharyngeal cancer
MedWire News: Transoral laser microsurgery offers excellent results in patients with advanced stage oropharyngeal cancer (OPC) who need tonsil or base of tongue resections, say US researchers.
The conclusion is based on a retrospective analysis and longitudinal observational study by Bruce Haughey (Washington University School of Medicine, St Louis, Missouri) and colleagues, and published in the journal Laryngoscope.
Transoral laser microsurgery is a minimally invasive surgical approach that uses intraoperative magnification to enable full resection of malignant tissue with minimal excision of surrounding normal tissue. "It therefore avoids dismantling the musculoskeletal structures of the neck, oral cavity, and pharynx," explain Haughey et al.
For the study, the team searched hospital records to identify patients with stage III/IV OPC who were treated with transoral laser microsurgery between 1996 and 2008. Patients were contacted and their swallowing function determined based on personal interview and review of medical records.
A total of 118 patients were included in the analysis, with a median follow-up of 53.9 months. In terms of staging, 44 patients were T1, 41 were T2, 23 were T3, and 10 were T4. Nearly all patients (98%) underwent neck dissection, 47% received adjuvant radiotherapy, and 41% received adjuvant chemotherapy.
Transoral laser microsurgery was well tolerated, write the authors, with 82% of patients reporting good swallowing function 1 month after surgery. Swallowing function then fell during adjuvant therapy, with just 55% of patients reporting good function at 3 months.
Swallowing function improved subsequently, however, and 89% and 88% of patients reported good function at 1 and 2 years post-surgery, respectively. Just 9% of patients had persistently poor function at 2 years.
In multivariate analysis, the only factor that predicted persistently poor swallowing was T4 stage disease; just 40% of this subgroup had good outcomes at 2 years compared with 93% of those with T1-3 stage disease.
Pre-existing comorbidities and conversion to open procedure were each associated with a delayed return of good swallowing function although not with persistently poor function. Finally, seven patients developed late-onset swallowing dysfunction, on average 34.3 months after surgery. The chief causes were cancer recurrence and side effects from adjuvant therapy.
Commenting on their data, Haughey et al note that poor swallowing is a "significant morbidity that affects many aspects of a patient's life," and say it "is therefore preferable for physicians to choose treatments that optimize swallowing function."
They conclude: "In this study we demonstrate that transoral laser microsurgery with or without adjuvant therapy for advanced stage oropharyngeal carcinoma results in very good, long-term swallowing function.
"Approximately 90% of patients enjoy good swallowing at 1 year after surgery. T1, T2 and T3 cases of both base of tongue and tonsil reliably recovered swallowing, usually by 1 year. T4 cases may have prolonged recovery, or persistently poor function."
By Joanna Lyford