Robotic Surgery for Oral Cancer Safer than Radiation Treatment

Daniel Marcus';

By Daniel Marcus

Posted on October 8th, 2019 in Robotic Center

According to the results presented at the American Society of Clinical Oncology’s Annual Meeting, 2018 held from June 1 to 5 in Chicago, Illinois, a definitive treatment modality for oropharyngeal squamous cell carcinoma (OPSCC) that helps avoid adverse effects of radiation includes Transoral Robotic-assisted Surgery (TORS) followed by chemotherapy and neck resections.

The incidence of oropharyngeal cancer in the United States has been on the rise. This could be because of the increasing number of human papillomavirus (HPV) infections, according to the National Cancer Institute. More than 50,000 cases of OPSCC are estimated to be reported in 2018.

TORS and Neck Dissection May Provide a Viable Alternative for the Standard Chemoradiation Treatment Recommended in HPV-Positive Patients

The patients with a diagnosis of OPSCC (treatment-naive stage III or IVA) having an Eastern Cooperative Oncology Group score less than 2 were included in the single-arm phase 2 study. The treatment plan that was followed included induction chemotherapy with Cisplatin and Docetaxel every 21 days for 3 cycles. After each cycle, tumor shrinkage was assessed and if the primary tumor was smaller by ≥80%, then TORS and neck dissections were performed. Tests performed during the postoperative period include:

  • blood tests
  • flexible laryngoscopy
  • imaging with positron emission tomography
  • CT and /or MRI

The treatment outcomes that were evaluated in the study included overall survival rate, progression-free survival, short and long-term toxicity, and quality of life.

The tumor size had decreased by 53.4% following the first induction cycle, 80% after the second cycle, and 90.5% following the third cycle. The investigators concluded that induction chemotherapy along with TORS and neck dissection can be considered an alternative for the standard chemoradiation treatment recommended in HPV-positive patients. Chemoradiation is recommended if the primary tumors do not shrink by 8% or more after the induction chemotherapy and patients with at least 1 lymph node-positive for disease following the surgery.

TORS - More Effective than Older Surgical Techniques

In general, chemoradiation or surgery with adjuvant radiation therapy is considered the standard of care for OPSCC treatment. Though these treatment methods are successful in curing oropharyngeal cancer 80-90% of the time, radiation therapy can be harmful and affect morbidity rates severely.

Moreover, radiation treatment can cause long-term side effects such as:

    • damage to the salivary glands
    • damage to the jaw bone
    • damage to the pituitary or thyroid gland
    • facial distortions
    • damage to teeth

As a result, the efficacy of a 2-drug induction chemotherapy regimen that is followed by TORS and neck dissection for the treatment of locally advanced OPSCC was assessed through a study. TORS was found to be easier and more effective than other old surgical techniques as it causes less damage and allows faster recovery. In addition, the risk of distal disease is reduced with this type of treatment.

Robotic Surgery for Oral Cancer at Cedars-Sinai Marina del Rey Hospital

Robotic-assisted surgery allows surgeons at Cedars-Sinai Marina del Rey Hospital to offer procedures that were previously not possible or not optimally done transorally, such as surgery for the base of tongue tumors and para pharyngeal tumors.

Compared to traditional open surgery, TORS offers the patient numerous potential advantages that include incision-less surgery, avoidance of tracheotomy, faster recovery, shorter hospital stay, significant preservation of swallowing function. The multidisciplinary head and neck cancer team at Cedars-Sinai Marina del Rey Hospital is committed to providing the highest quality care possible for our patients.