A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: A systematic review

Objectives/Hypothesis To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T‐stage oropharyngeal cancer. Data Sources The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studi...

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Published in:The Laryngoscope 2014-09, Vol.124 (9), p.2096-2102
Main Authors: de Almeida, John R., Byrd, James K., Wu, Rebecca, Stucken, Chaz L., Duvvuri, Uma, Goldstein, David P., Miles, Brett A., Teng, Marita S., Gupta, Vishal, Genden, Eric M.
Format: Article
Language:English
Subjects:
adverse events
Cancer
Combined Modality Therapy
Drug therapy
Humans
IMRT
Mouth
Neoplasm Staging
Oropharyngeal Neoplasms - pathology
Oropharyngeal Neoplasms - radiotherapy
Oropharyngeal Neoplasms - surgery
oropharynx cancer
Ostomy
outcomes
Radiation therapy
Radiotherapy, Intensity-Modulated
Robotics - methods
Studies
Surgery
survival
TORS
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Summary:Objectives/Hypothesis To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T‐stage oropharyngeal cancer. Data Sources The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012. Methods Studies included patients treated for early T‐stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment‐ specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised. Results Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two‐year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)—and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge. Conclusion This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events. Laryngoscope, 124:2096–2102, 2014
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.24712