Robotic Surgery Beneficial in HPV-, Non-HPV-Related Oral Cancer

WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.

WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.

WASHINGTON – Oropharyngeal squamous cell cancer patients who underwent transoral robotic surgery had an overall 2-year survival rate of 87%, with no significant differences between patients who were positive vs. negative for the human papillomavirus, based on data from 52 patients.

HPV is associated with 45%-70% of cases of oropharyngeal squamous cell carcinoma (OPSCCa), said Dr. Kiran Kakarala, who conducted the study at Ohio State University in Columbus.

Previous studies have shown a significant difference in survival rates for patients with HPV-positive tumors, compared with those with negative tumors, Dr. Kakarala said. However, other studies have suggested that the use of transoral robotic surgery (TORS) for OPSCCa patients could narrow the gap in survival based on HPV status.

Dr. Kakarala and his colleagues reviewed data from 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment for previously untreated OPSCCa. The patients were part of a prospective single-arm cohort study at a single academic medical center.

HPV status was available for 42 patients; 36 were positive and 6 were negative. Demographic characteristics were not significantly different between the HPV-positive and negative patients. The mean age of the HPV-positive patients was 59 years, and the mean age of the negative patients was 57 years. The tonsil was the primary tumor site in 89% of the positive patients and 83% of the negative patients; the base of the tongue was the primary site in 11% of the positive patients and 17% of the negative patients.

HPV-positive patients had significantly higher N classifications based on the TNM Classification of Malignant Tumors, compared with HPV-negative patients (P = .015), and a significantly higher stage (P = .017). No significant differences were found in the number of HPV-positive vs. negative patients who received postoperative radiation or chemotherapy.

The 2-year survival rate was 87% for all 52 patients, 92% for HPV-positive patients, and 75% for HPV-negative patients. Two-year disease-specific survival rates were 92%, 92%, and 75%, respectively. Two-year disease-free survival rates were 86%, 97%, and 50%, respectively.

"The 2-year overall survival and disease-specific survival were not statistically different between HPV-positive and negative patients treated with TORS followed by radiation with or without chemotherapy as indicated," Dr. Kakarala said.

The study was limited by its small size and retrospective design, but the findings suggest a role for minimally invasive TORS in OPSCCa patients, he said.

"Randomized trials incorporating minimally invasive transoral surgical procedures with radiation therapy and chemotherapy, and comparing survival, quality of life, and cost outcomes between these treatment modalities, are indicated," he added.

The findings were presented at the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Dr. Kakarala had no financial conflicts to disclose.