Transoral laser microsurgery and radiotherapy for oropharyngeal squamous cell carcinoma: Equitable survival and enhanced function compared with contemporary standards of care. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Dalton, C. Lucy; Milinis, Kristijonas; Houghton, David; Ridley, Paul; Davies, Katharine; Williams, Richard; Hamilton, David; Wilkie, Mark D.; Markey, Anne; Clarke, Kim; Lofthouse, Matthew; Helliwell, Timothy R.; Triantafyllou, Asterios; Rodrigues, Jennifer; Bheemireddy, Krishna; Hanlon, Rebecca; Wieshmann, Hulya; Haridass, Anoop; Brammer, Caroline; Husband, David; Shenoy, Aditya; Loh, Christopher; Roland, Nicholas J.; Bekiroglu, Fazilet; Tandon, Sankalap; Lancaster, Jeffrey; Jones, Terence M.
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 11(2020)
• Page Start: 2042
• Page End: 2049
• Publication Date: 2020-11
• Subjects: Transoral laser microsurgery -- Oropharyngeal squamous cell cancer -- Human papillomavirus -- Fibrin glue -- External carotid artery -- Swallowing; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.06.045
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: We describe the 5-year oncological and functional outcomes of transoral laser microsurgery, neck dissection (TLM + ND) and adjuvant radiotherapy (PORT) used to treat patients with oropharyngeal carcinoma. The effectiveness of external carotid artery (ECA) ligation in reducing post-operative bleeding, and fibrin glue following ND in reducing wound drainage and length of hospital stay is reported. Materials and methods: This retrospective case review of consecutive patients undergoing TLM between 2006 and 2017 used the Kaplan-Meier Estimator and Log-Rank Test for univariate, time-to-event analyses, and Cox-Proportionate Hazard modelling for multivariate analysis. Results: 264 consecutive patients were included. Mean follow-up was 49.4 months. 219 (82.9%) patients received PORT. Five-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 74.9%, 73.7%, and 86.2%, respectively. Five-year locoregional control was 89.4%. 65.5% of cases were Human papillomavirus associated (HPV+), for whom OS, DFS and DSS was 85.6%, 84.7% and 92.7%, respectively, and demonstrated significantly higher OS (hazard ratio (HR) 0.28, CI 0.16–0.49, p < 0.0001), DFS (HR 0.28, CI 0.17–0.47, p < 0.0001) and DSS (HR 0.2, CI 0.09–0.44, <0.001). Post-operative oropharyngeal bleeding occurred in 23 patients (8.7%), of which 5 were major/severe, in patients without ECA ligation. Fibrin glue significantly reduced neck drain output (p < 0.001), and length of hospital stay (p < 0.001). One-year gastrostomy dependence rate was 2.3%. Conclusions: TLM + ND + PORT results in favourable 5-year survival and locoregional control rates, and low feeding tube dependency rates. ECA ligation and fibrin glue appear to reduce major post-operative haemorrhage, wound drainage and length of hospital stay.