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Head & Neck Apr 2016Transoral surgery (TOS) for patients with early stage oropharyngeal squamous cell carcinoma (SCC) is increasingly used, however, criticized, because of less optimal... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Transoral surgery (TOS) for patients with early stage oropharyngeal squamous cell carcinoma (SCC) is increasingly used, however, criticized, because of less optimal access to the tumor than open techniques and thus potentially jeopardizing tumor control in comparison with radiotherapy (RT). Therefore, we compared the currently available data on survival provided by TOS versus RT.
METHODS
Survival data were extracted after a MEDLINE, Web of Science, and Google Scholar search followed by a meta-analysis.
RESULTS
The analysis was based on 729 patients in the RT group versus 276 in the TOS group with similar quality of studies in both groups. The 5-year disease-specific survival (DSS)/overall survival (OS) was 90.4% (95% confidence interval [CI], 85.6% to 95.2%/58.8%; 95% CI, 52.8% to 64.7%) in the RT group versus 89.6% (95% CI, 81.8% to 97.3%/78.1%; 95% CI, 71.2% to 85.1%) in the TOS group.
CONCLUSION
The data suggest equivalent efficacy of both treatments in terms of disease control for early stage oropharyngeal SCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: 2143-2150.
Topics: Carcinoma, Squamous Cell; Humans; Oropharyngeal Neoplasms; Survival Analysis; Treatment Outcome
PubMed: 25546375
DOI: 10.1002/hed.23995 -
Oral Oncology Dec 2023Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is paramount to preventing local recurrence (LR), but the necessary surgical margin dimension remains contentious.
METHODS
Systematic review and meta-analysis of studies reporting margin status and LR following TORS without adjuvant therapy for primary OPSCC.
RESULTS
The search identified 269 articles and 11 were selected for inclusion, with 406 patients included in the meta-analysis. Heterogeneity was noted in the definition of "close" margins. Random-effects pooled rate of positive margins was 7 % (95 % CI 0.04-0.12, I = 54 %, p = 0.02) and close margins was 7 % (95 % CI 0.02-0.27, I = 86 %, p=<0.01). The random-effects overall rate of LR was 6 % (95 % CI 0.04-0.10, I = 11 %, p = 0.35), 13 % (95 % CI 0.02-0.620, I = 0 %, p = 1.0) after a positive margin, and 3 % (95 % CI 0.03-0.24, I = 23 %, p = 0.26) after a close margin. Odds ratio (OR) for LR indicated higher risk of LR for positive compared to close margins (7.5; 95 % CI 1.31-42.91, I = 0 %, p = 0.51), and a slightly lower risk of LR between close and negative margins (2.22; 95 % CI 0.67-7.38, I = 0 %, p = 0.8). A lack of frozen-section analysis (OR 2.91, p = 0.36) and HPV-negative disease (OR 1.68, p = 0.03) were associated with an elevated risk of LR.
CONCLUSIONS
TORS as a standalone treatment is associated with low rates of LR; however, the literature is hampered by considerable heterogeneity in margin definitions. Larger multicentre studies are required to determine the precise margin cut-off required for oropharyngeal tumours managed with TORS alone.
Topics: Humans; Margins of Excision; Robotic Surgical Procedures; Combined Modality Therapy; Oropharyngeal Neoplasms; Odds Ratio; Retrospective Studies; Neoplasm Recurrence, Local
PubMed: 37951118
DOI: 10.1016/j.oraloncology.2023.106610 -
PloS One 2022Adjuvant radiotherapy is the standard of care in locally advanced head and neck cancers. The radiation field is correlated with the surgical field in the adjuvant...
OBJECTIVES
Adjuvant radiotherapy is the standard of care in locally advanced head and neck cancers. The radiation field is correlated with the surgical field in the adjuvant radiotherapy setting; therefore, tailoring the irradiation field is reasonable.
MATERIALS AND METHODS
We retrospectively analyzed patients with oral cavity and oropharyngeal cancers included in the cancer registry between 2015 and 2019 in the study hospital. Patients who underwent whole-neck irradiation (WNI) were compared with those who underwent lower-neck-sparing (LNS) irradiation.
RESULTS
A total of 167 patients with oral cavity and oropharyngeal cancers were included in the study. Cancer recurrence was recorded in 33% of the patients. The rate of recurrence of oral cavity and oropharyngeal cancer at neck level IV was 8%. The 2-year incidence of level IV recurrence was lower in the WNI group than in the LNS group (2% vs. 10%; p = 0.04). The 2-year disease-free survival rates were 75% and 63% in the WNI and LNS groups, respectively (p = 0.08).
CONCLUSION
The rate of level IV recurrence was higher in the LNS group than in the WNI group. Trends of improvement in disease-free survival with lower-neck irradiation suggested that it is premature to consider LNS irradiation as daily practice in patients with oral cavity and oropharyngeal cancer.
Topics: Feasibility Studies; Humans; Mouth Neoplasms; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Radiotherapy, Adjuvant; Retrospective Studies
PubMed: 35404969
DOI: 10.1371/journal.pone.0266678 -
European Archives of... Jan 2011Oropharyngeal squamous cell carcinomas (OSCC) constitute about 5% of all cancers in the western world and the incidence and mortality rates of this tumor have shown... (Review)
Review
Oropharyngeal squamous cell carcinomas (OSCC) constitute about 5% of all cancers in the western world and the incidence and mortality rates of this tumor have shown little improvement over the last 30 years. Molecular targeted therapy, a promising strategy for the treatment of OSCC and other cancers, requires the understanding of specific molecular events of carcinogenesis and the different pathological, partly interrelated pathways. Extended knowledge of the prognostic or predictive value of molecular biomarkers in oropharyngeal cancer is necessary to allow a better characterization and classification of the tumor, improve the appraisal of clinical outcome and help to specify individual multimodal therapy with increased efficiency. This work affords an updated summary regarding recent data about tissue biomarkers in patients with OSCC, based on the six essential hallmarks of cancer described by Hanahan and Weinberg (Cell 100(1):57-70, 2000) providing the characterization of a malignant cell.
Topics: Biomarkers, Tumor; Carcinoma, Squamous Cell; Humans; Immunohistochemistry; Molecular Targeted Therapy; Neoplasm Invasiveness; Neoplasm Metastasis; Oropharyngeal Neoplasms; Papillomaviridae; Predictive Value of Tests; Prognosis
PubMed: 20827554
DOI: 10.1007/s00405-010-1369-x -
Head & Neck Sep 2015A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and... (Comparative Study)
Comparative Study
BACKGROUND
A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and clinical outcomes remain poor.
METHODS
We evaluated patient, tumor, and treatment characteristics for 200 veterans with oropharyngeal SCC treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012.
RESULTS
Most patients (77%) were white and heavy smokers. Twenty-seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival (OS) at 5 years was 40%. Survival was impacted by T classification, treatment intensity, completion of treatment, and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with National Comprehensive Cancer Network (NCCN) guidelines.
CONCLUSION
Oropharyngeal SCC in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation.
Topics: Adult; Aged; Alcoholism; Carcinogens; Carcinoma, Squamous Cell; Chemoradiotherapy; Cohort Studies; Disease-Free Survival; Hospitals, Veterans; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Smoking; Survival Analysis; Veterans
PubMed: 24801106
DOI: 10.1002/hed.23740 -
Cancer May 1998
Topics: Carcinoma; Humans; Neoplasm Staging; Oropharyngeal Neoplasms
PubMed: 9576277
DOI: 10.1002/(sici)1097-0142(19980501)82:9<1611::aid-cncr2>3.0.co;2-d -
Oral Oncology Sep 2021
Topics: Carcinoma; Head and Neck Neoplasms; Humans; Neoplasm Metastasis; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 33883078
DOI: 10.1016/j.oraloncology.2021.105286 -
p16 Expression as a predictive biomarker of hypoxic cell-sensitizing agents in oropharyngeal cancer.Journal of Clinical Oncology : Official... Sep 2010
Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Carcinoma, Squamous Cell; Cell Hypoxia; Chemotherapy, Adjuvant; Cisplatin; Cyclin-Dependent Kinase Inhibitor p16; DNA, Viral; Disease-Free Survival; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Radiotherapy, Adjuvant; Risk Assessment; Risk Factors; Time Factors; Tirapazamine; Treatment Outcome; Triazines
PubMed: 20697096
DOI: 10.1200/JCO.2010.30.6035 -
Head & Neck Jan 2016The purpose of this study was to determine clinical factors that predict locoregional recurrence or distant metastasis in patients with human papillomavirus...
BACKGROUND
The purpose of this study was to determine clinical factors that predict locoregional recurrence or distant metastasis in patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated with surgery and guideline-indicated adjuvant therapy.
METHODS
We identified all presumed HPV-positive patients with oropharyngeal cancer in our health system from January 2010 to August 2012 treated with surgery and guideline-indicated adjuvant therapy. Statistical analysis was performed to identify clinical predictors associated with treatment failure.
RESULTS
One hundred fourteen p16+ oropharyngeal cancers managed with initial surgical resection were identified. Median follow-up was 17 months. Two-year locoregional failure was 3.3% and distant failure was 8.4%. Statistical analysis found that conventional poor prognostic features did not predict treatment failure.
CONCLUSION
Locoregional recurrence and development of distant metastatic disease are uncommon in patients who are appropriately selected for surgical management of p16+ oropharyngeal cancer regardless of the presence or absence of conventional poor prognostic features.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Female; Follow-Up Studies; Human papillomavirus 16; Humans; Immunocompromised Host; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomavirus Infections; Retrospective Studies; Risk Factors; Robotic Surgical Procedures; Smoking; Treatment Failure
PubMed: 25197014
DOI: 10.1002/hed.23850 -
European Archives of... Mar 2017The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the...
The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [<50% within GTV but >50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.
Topics: Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Salvage Therapy; Treatment Failure
PubMed: 27942891
DOI: 10.1007/s00405-016-4413-7