Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal cancer

Outcomes and prognostic factors

Authors


  • Presented at the Triological Society Southern and Middle Combined Sections Meeting, Bonita Springs, Florida, U.S.A., January 8–11, 2009.

  • This study was performed at Washington University School of Medicine, St. Louis, Missouri, U.S.A. The authors have no conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Document survival, prognostic variables, and functional outcomes of patients with AJCC stage III or IV oropharyngeal cancer, treated with transoral laser microsurgery (TLM) ± adjuvant therapy.

Study Design:

Analysis of prospectively assembled data pertaining to the above-described patient cohort.

Methods:

Patients treated with TLM for AJCC stage III or IV oropharyngeal cancer at Washington University School of Medicine from 1996 to 2006 were followed for a minimum of 2 years. Recurrence, survival, functional, and human papilloma virus data were analyzed.

Results:

Eighty-four patients met inclusion criteria. Mean follow-up was 52.6 months. Overall AJCC stages were: III 15% and IV 85%. T stages were T1–2, 74%; T3–4, 26%. Eighty-three patients underwent neck dissection, 50 received adjuvant radiotherapy, and 28 received adjuvant chemoradiotherapy. Overall survival at 2 and 5 years was 94% and 88%, respectively. Disease-specific survival at 2 and 5 years was 96% and 92%, respectively. Six patients recurred (7%): locally (one), regionally (four), and distant (five). T stage, positive margins, and p16 status significantly impacted survival. The addition of adjuvant chemotherapy in high-risk patients did not significantly impact survival. Five patients (6%) had major surgical complications, but without mortality. Eighty-one percent of patients had acceptable swallowing function at last follow-up. Immediately postoperatively, 17% required G-tubes, which dropped to 3.4% of living patients at 3 years.

Conclusions:

In this population, our findings validate TLM ± adjuvant therapy as a highly effective strategy for survival, locoregional control, and swallowing recovery in AJCC stage III and IV oropharyngeal cancer. Our finding also show that p16 positivity improves survival. Laryngoscope, 2009

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