2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

TABLE VI. Disease-Related Outcomes.

TORS Alone

Adjuvant RT

Adjuvant CRT

P Value

Total LR recurrence

.23

Yes

0 (0.0%)

1 (3.2%)

8 (12.1%)

No

12 (100.0%)

30 (96.8%)

58 (87.9%)

Total distant recurrence

.05*

Yes

0 (0.0%)

0 (0.0%)

9 (13.6%)

No

12 (100.0%)

31 (100.0%)

57 (86.4%)

HPV 1 LR recurrence

1.00

Yes

0 (0.0%)

1 (4.4%)

2 (4.4%)

No

6 (100.0%)

22 (95.6)

44 (95.6%)

HPV 1 distant recurrence

.24

Yes

0 (0.0%)

0 (0.0%)

5 (10.9%)

No

6 (100.0%)

23 (100.0%)

41 (89.1%)

HPV 2 LR recurrence

.26

Yes

0 (0.0%)

0 (0.0%)

3 (25.0%) 9 (75.0%)

No

4 (100.0%)

7 (100.0%)

HPV 2 distant recurrence

.67

Yes

0 (0.0%)

0 (0.0%)

2 (16.7%)

No

4 (100.0%)

7 (100.0%)

10 (83.3%)

HPV Status

Positive

Negative

.05 †

LR recurrence

Yes

3 (3.9%)

4 (16.7%)

No

73 (96.1%)

20 (83.3%)

Distant recurrence

.67

Yes

5 (6.6%)

2 (8.3%)

No

71 (93.4%)

22 (91.7%)

*A greater proportion of those in the TORS alone and adjuvant RT groups had distant disease control compared to those in the adjuvant CRT group (100% vs. 100% vs. 86%). † A greater proportion of those in the HPV positive group had locoregional disease control compared to those in the HPV negative group (96% vs. 83%). CRT 5 chemoradiation therapy; HPV 5 human papillomavirus; LR 5 locoregional; RT 5 radiation therapy; TORS 5 transoral robotic surgery.

CRT significantly diminished long-term QOL and func- tional outcomes postoperatively with comparable clinical outcomes to TORS alone. Future studies should include a multi-institutional, detailed examination of the effect of different doses and frequencies of adjuvant treatment on clinical, functional, and QOL outcomes to determine an ideal amount of adjuvant therapy. CONCLUSION For OPSCCA patients treated with TORS, the mor- bidity and functional deterioration associated with adju- vant therapy is an important consideration. Although TORS is a promising, innovative procedure, assessment of its short-term and long-term effects on human health can contribute to maximizing patient function and mini- mizing treatment toxicities. Adjuvant RT and CRT appear to negatively affect QOL. Further studies are warranted to investigate the effects and optimization of adjuvant therapy in this patient population. Acknowledgments The authors thank the Clinical Trials Office at The Ohio State University for their assistance with this project.

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