TY - JOUR
T1 - Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal Cancer
T2 - Outcomes and prognostic factors
AU - Rich, Jason T.
AU - Milov, Simon
AU - Lewis, James S.
AU - Thorstad, Wade L.
AU - Adkins, Douglas R.
AU - Haughey, Bruce H.
PY - 2009/9
Y1 - 2009/9
N2 - 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.
AB - 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.
KW - Advanced stage oropharyngeal cancer
KW - Chemoradiotherapy
KW - Human papilloma virus
KW - P16
KW - Tongue base
KW - Tonsil
KW - Transoral laser microsurgery
UR - http://www.scopus.com/inward/record.url?scp=70349587706&partnerID=8YFLogxK
U2 - 10.1002/lary.20552
DO - 10.1002/lary.20552
M3 - Article
C2 - 19572271
AN - SCOPUS:70349587706
SN - 0023-852X
VL - 119
SP - 1709
EP - 1719
JO - Laryngoscope
JF - Laryngoscope
IS - 9
ER -