Background. Transoral robotic surgery (TORS) is an emerging treatment option for the treatment of head and neck malignancies, particularly for oropharyngeal squamous cell carcinoma (OPSCC). Preliminary studies have demonstrated excellent oncologic and functional outcomes that have led to a resurgence of interest in the primary surgical management of OPSCC. The aim of the present study was to review the evidence base supporting the use of TORS in OPSCC. Methods. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and more specifically OPSCC, were identified for review. Further searches were made of reference lists for complete evaluation of minimally invasive surgery (MIS) in treating OPSCC. Results. Seventeen results relating to the application of TORS in treatment of OPSCC were identified. Further results relating to the role of transoral laser microsurgery (TLM) in OPSCC were included for review. Feasibility, oncologic, and functional data is summarized and discussed. Discussion. Management strategies for patients with OPSCC continue to evolve. Minimally invasive surgical techniques including TORS and TLM offer impressive functional and oncologic outcomes particularly for patients with early T-classification and low-volume regional metastatic disease. Potential exists for treatment deintensification, particularly in patients who are HPV positive. 1. Introduction Approximately 500,000 new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed each year making HNSCC the 6th most common cancer worldwide [1]. The rate of HNSCC has been increasing recently secondary to an epidemic of human papillomavirus- (HPV-) related oropharyngeal squamous cell cancer (OPSCC). These trends, which have seen rates of OPSCC as much as double over the last three decades in some countries, have been associated with a shift in demographics to a younger population that is typically high functioning with lower rates of comorbid illness [2]. Combined with lower rates of smoking and alcohol abuse and an intrinsic improved response rate of HPV-related OPSCC to curative treatment regimens, the overall and disease-free survival rates in this patient group are significantly higher than previously observed. As such, long-term quality of life considerations have been made even more relevant to the multidisciplinary team coordinating the care of these patients. These new developments in the pathogenesis of HNSCC, and in particular OPSCC, are occurring in the context of large-scale paradigm shifts over the past two
References
[1]
J. Ferlay, H. R. Shin, F. Bray, D. Forman, C. Mathers, and D. M. Parkin, “Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008,” International Journal of Cancer, vol. 127, no. 12, pp. 2893–2917, 2010.
[2]
A. N？sman, P. Attner, L. Hammarstedt et al., “Incidence of human papillomavirus (HPV) positive tonsillar carcinoma in Stockholm, Sweden: an epidemic of viral-induced carcinoma?” International Journal of Cancer, vol. 125, no. 2, pp. 362–366, 2009.
[3]
The Department of Veterans Affairs Laryngeal Cancer Study Group, “Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer,” New England Journal of Medicine, vol. 324, no. 24, pp. 1685–1690, 1991.
[4]
G. S. Weinstein, B. W. O'Malley, and N. G. Hockstein, “Transoral robotic surgery: supraglottic laryngectomy in a canine model,” Laryngoscope, vol. 115, no. 7, pp. 1315–1319, 2005.
[5]
N. G. Hockstein, B. W. O'Malley, and G. S. Weinstein, “Assessment of intraoperative safety in transoral robotic surgery,” Laryngoscope, vol. 116, no. 2, pp. 165–168, 2006.
[6]
N. G. Hockstein, G. S. Weinstein, and B. W. O'Malley, “Maintenance of hemostasis in transoral robotic surgery,” ORL, vol. 67, no. 4, pp. 220–224, 2005.
[7]
C. Vicini, I. Dallan, P. Canzi et al., “Transoral robotic surgery of the tongue base in obstructive sleep apnea-hypopnea syndrome: anatomic considerations and clinical experience,” Head and Neck, vol. 34, no. 1, pp. 15–22, 2012.
[8]
C. Vicini, I. Dallan, P. Canzi, S. Frassineti, M. G. La Pietra, and F. Montevecchi, “Transoral robotic tongue base resection in obstructive sleep apnoea-hypopnoea syndrome: a preliminary report,” ORL, vol. 72, no. 1, pp. 22–27, 2010.
[9]
R. R. Walvekar, G. Peters, E. Hardy et al., “Robotic-assisted transoral removal of a bilateral floor of mouth ranulas,” World Journal of Surgical Oncology, vol. 9, p. 78, 2011.
[10]
R. R. Walvekar, P. D. Tyler, N. Tammareddi, and G. Peters, “Robotic-assisted transoral removal of a submandibular megalith,” Laryngoscope, vol. 121, no. 3, pp. 534–537, 2011.
[11]
G. S. Weinstein, B. W. O'Malley, W. Snyder, E. Sherman, and H. Quon, “Transoral robotic surgery: radical tonsillectomy,” Archives of Otolaryngology-Head and Neck Surgery, vol. 133, no. 12, pp. 1220–1226, 2007.
[12]
B. W. O'Malley, G. S. Weinstein, W. Snyder, and N. G. Hockstein, “Transoral robotic surgery (TORS) for base of tongue neoplasms,” Laryngoscope, vol. 116, no. 8, pp. 1465–1472, 2006.
[13]
M. A. Cohen, G. S. Weinstein, B. W. O'Malley Jr, M. Feldman, and H. Quon, “Transoral robotic surgery and human papillomavirus status: oncologic results,” Head and Neck, vol. 33, no. 4, pp. 573–580, 2011.
[14]
E. J. Moore, K. D. Olsen, and J. L. Kasperbauer, “Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes,” Laryngoscope, vol. 119, no. 11, pp. 2156–2164, 2009.
[15]
K. Aubry, M. Yachine, A.-F. Perez et al., “Transoral robotic surgery for head and neck cancer: a series of 17 cases,” European Annals of Otorhinolaryngology, Head and Neck Diseases, vol. 128, no. 6, pp. 290–296, 2011.
[16]
E. M. Genden, S. Desai, and C. K. Sung, “Transoral robotic surgery for the management of head and neck cancer: a preliminary experience,” Head and Neck, vol. 31, no. 3, pp. 283–289, 2009.
[17]
V. K. Mukhija, C.-K. Sung, S. C. Desai, G. Wanna, and E. M. Genden, “Transoral robotic assisted free flap reconstruction,” Otolaryngology-Head and Neck Surgery, vol. 140, no. 1, pp. 124–125, 2009.
[18]
B. A. Boudreaux, E. L. Rosenthal, J. S. Magnuson et al., “Robot-assisted surgery for upper aerodigestive tract neoplasms,” Archives of Otolaryngology-Head and Neck Surgery, vol. 135, no. 4, pp. 397–401, 2009.
[19]
G. Lawson, N. Matar, M. Remacle, J. Jamart, and V. Bachy, “Transoral robotic surgery for the management of head and neck tumors: learning curve,” European Archives of Oto-Rhino-Laryngology, vol. 268, no. 12, pp. 1795–1801, 2011.
[20]
E. M. Genden, T. Kotz, C. C. L. Tong et al., “Transoral robotic resection and reconstruction for head and neck cancer,” Laryngoscope, vol. 121, no. 8, pp. 1668–1674, 2011.
[21]
J. C. Selber, G. Robb, J. M. Serletti, G. Weinstein, R. Weber, and F. C. Holsinger, “Transoral robotic free flap reconstruction of oropharyngeal defects: a preclinical investigation,” Plastic and Reconstructive Surgery, vol. 125, no. 3, pp. 896–900, 2010.
[22]
J. C. Selber, “Transoral robotic reconstruction of oropharyngeal defects: a case series,” Plastic and Reconstructive Surgery, vol. 126, no. 6, pp. 1978–1987, 2010.
[23]
E. M. Genden, R. Park, C. Smith, and T. Kotz, “The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection,” Archives of Otolaryngology-Head and Neck Surgery, vol. 137, no. 2, pp. 151–156, 2011.
[24]
T. A. Ghanem, “Transoral robotic-assisted microvascular reconstruction of the oropharynx,” Laryngoscope, vol. 121, no. 3, pp. 580–582, 2011.
[25]
E. S. Garfein, P. J. Greaney Jr, B. Easterlin, B. Schiff, and R. V. Smith, “Transoral robotic reconstructive surgery reconstruction of a tongue base defect with a radial forearm flap,” Plastic and Reconstructive Surgery, vol. 127, no. 6, pp. 2352–2354, 2011.
[26]
N. R. Dean, E. L. Rosenthal, W. R. Carroll et al., “Robotic-assisted surgery for primary or recurrent oropharyngeal carcinoma,” Archives of Otolaryngology-Head and Neck Surgery, vol. 136, no. 4, pp. 380–384, 2010.
[27]
Y. M. Park, J. G. Lee, W. S. Lee, E. C. Choi, S. M. Chung, and S. H. Kim, “Feasibility of transoral lateral oropharyngectomy using a robotic surgical system for tonsillar cancer,” Oral Oncology, vol. 45, no. 8, pp. e62–e66, 2009.
[28]
G. S. Weinstein, B. W. O'Malley, M. A. Cohen, and H. Quon, “Transoral robotic surgery for advanced oropharyngeal carcinoma,” Archives of Otolaryngology-Head and Neck Surgery, vol. 136, no. 11, pp. 1079–1085, 2010.
[29]
H. N. White, E. J. Moore, E. L. Rosenthal et al., “Transoral robotic-assisted surgery for head and neck squamous cell carcinoma: one- and 2-year survival analysis,” Archives of Otolaryngology-Head and Neck Surgery, vol. 136, no. 12, pp. 1248–1252, 2010.
[30]
W. Steiner, O. Fierek, P. Ambrosch, C. P. Hommerich, and M. Kron, “Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue,” Archives of Otolaryngology-Head and Neck Surgery, vol. 129, no. 1, pp. 36–43, 2003.
[31]
B. H. Haughey, M. L. Hinni, J. R. Salassa et al., “Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a united states multicenter study,” Head and Neck, vol. 33, no. 12, pp. 1683–1694, 2011.
[32]
D. G. Grant, M. L. Hinni, J. R. Salassa, W. C. Perry, R. E. Hayden, and J. D. Casler, “Oropharyngeal cancer: a case for single modality treatment with transoral laser microsurgery,” Archives of Otolaryngology-Head and Neck Surgery, vol. 135, no. 12, pp. 1225–1230, 2009.
[33]
T. A. Iseli, B. D. Kulbersh, C. E. Iseli, W. R. Carroll, E. L. Rosenthal, and J. S. Magnuson, “Functional outcomes after transoral robotic surgery for head and neck cancer,” Otolaryngology-Head and Neck Surgery, vol. 141, no. 2, pp. 166–171, 2009.
[34]
W. Li, C. H. Thompson, C. J. O'Brien et al., “Human papillomavirus positivity predicts favourable outcome for squamous carcinoma of the tonsil,” International Journal of Cancer, vol. 106, no. 4, pp. 553–558, 2003.
[35]
L. Licitra, F. Perrone, P. Bossi et al., “High-risk human papillomavirus affects prognosis in patients with surgically treated oropharyngeal squamous cell carcinoma,” Journal of Clinical Oncology, vol. 24, no. 36, pp. 5630–5636, 2006.
[36]
H. Mellin, S. Friesland, R. Lewensohn, T. Dalianis, and E. Munck-Wikland, “Human papilloma virus (HPV) DNA in tonsillar cancer: clinical correlates, risk of relapse, and survival,” International Journal of Cancer, vol. 89, no. 3, pp. 300–304, 2000.
[37]
K. K. Ang, J. Harris, R. Wheeler et al., “Human papillomavirus and survival of patients with oropharyngeal cancer,” New England Journal of Medicine, vol. 363, no. 1, pp. 24–35, 2010.
[38]
A. C. Nichols, D. M. Finkelstein, W. C. Faquin et al., “Bcl2 and human papilloma virus 16 as predictors of outcome following concurrent chemoradiation for advanced oropharyngeal cancer,” Clinical Cancer Research, vol. 16, no. 7, pp. 2138–2146, 2010.
[39]
L. B. Harrison, M. J. Zelefsky, J. G. Armstrong, E. Carper, J. J. Gaynor, and R. B. Sessions, “Performance status after treatment for squamous cell cancer of the base of tongue-a comparison of primary radiation therapy versus primary surgery,” International Journal of Radiation Oncology Biology Physics, vol. 30, no. 4, pp. 953–957, 1994.
[40]
D. A. Fein, W. R. Lee, W. R. Amos et al., “Oropharyngeal carcinoma treated with radiotherapy: a 30-year experience,” International Journal of Radiation Oncology Biology Physics, vol. 34, no. 2, pp. 289–296, 1996.
[41]
J. T. Parsons, W. M. Mendenhall, S. P. Stringer et al., “Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both,” Cancer, vol. 94, no. 11, pp. 2967–2980, 2002.
[42]
J. Staffurth8 and Radiotherapy Development Board, “A review of the clinical evidence for intensity-modulated radiotherapy,” Clinical Oncology, vol. 22, no. 8, pp. 643–657, 2010.
[43]
P. Blanchard, B. Baujat, V. Holostenco et al., “Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site,” Radiotherapy and Oncology, vol. 100, no. 1, pp. 33–40, 2011.
[44]
J. Bourhis, J. Overgaard, H. Audry et al., “Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis,” The Lancet, vol. 368, no. 9538, pp. 843–854, 2006.
[45]
M. Machtay, J. Moughan, A. Trotti et al., “Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis,” Journal of Clinical Oncology, vol. 26, no. 21, pp. 3582–3589, 2008.
[46]
J. J. Caudell, P. E. Schaner, R. F. Meredith et al., “Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer,” International Journal of Radiation Oncology Biology Physics, vol. 73, no. 2, pp. 410–415, 2009.
[47]
J. A. Bonner, P. M. Harari, J. Giralt et al., “Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck,” New England Journal of Medicine, vol. 354, no. 6, pp. 567–578, 2006.
[48]
F. C. Holsinger, A. J. McWhorter, M. Ménard, D. Garcia, and O. Laccourreye, “Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: I. Technique, complications, and functional results,” Archives of Otolaryngology-Head and Neck Surgery, vol. 131, no. 7, pp. 583–591, 2005.
[49]
O. Laccourreye, S. Hans, M. Ménard, D. Garcia, D. Brasnu, and F. C. Holsinger, “Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence,” Archives of Otolaryngology-Head and Neck Surgery, vol. 131, no. 7, pp. 592–599, 2005.
[50]
D. K. Henstrom, E. J. Moore, K. D. Olsen, J. L. Kasperbauer, and M. E. McGree, “Transoral resection for squamous cell carcinoma of the base of the tongue,” Archives of Otolaryngology-Head and Neck Surgery, vol. 135, no. 12, pp. 1231–1238, 2009.
[51]
J. T. Rich, J. Liu, and B. H. Haughey, “Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer,” Laryngoscope, vol. 121, no. 11, pp. 2381–2390, 2011.
[52]
J. T. Rich, S. Milov, J. S. Lewis, W. L. Thorstad, D. R. Adkins, and B. H. Haughey, “Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal Cancer: outcomes and prognostic factors,” Laryngoscope, vol. 119, no. 9, pp. 1709–1719, 2009.
[53]
G. S. Weinstein, H. Quon, B. W. O'Malley, G. G. Kim, and M. A. Cohen, “Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial,” Laryngoscope, vol. 120, no. 9, pp. 1749–1755, 2010.
[54]
M. Moncrieff, J. Sandilla, J. Clark et al., “Outcomes of Primary surgical treatment of T1 and T2 carcinomas of the oropharynx,” Laryngoscope, vol. 119, no. 2, pp. 307–311, 2009.
[55]
R. R. Walvekar, R. J. Li, W. E. Gooding et al., “Role of surgery in limited (T1-2, N0-1) cancers of the oropharynx,” Laryngoscope, vol. 118, no. 12, pp. 2129–2134, 2008.
[56]
F. F. de Arruda, D. R. Puri, J. Zhung et al., “Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the memorial sloan-kettering cancer center experience,” International Journal of Radiation Oncology Biology Physics, vol. 64, no. 2, pp. 363–373, 2006.
[57]
K. E. Rusthoven, D. Raben, A. Ballonoff, M. Kane, J. I. Song, and C. Chen, “Effect of radiation techniques in treatment of oropharynx cancer,” Laryngoscope, vol. 118, no. 4, pp. 635–639, 2008.
[58]
K. Huang, P. Xia, C. Chuang et al., “Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: the university of California-San Francisco experience,” Cancer, vol. 113, no. 3, pp. 497–507, 2008.
[59]
J. D. Lawson, K. Otto, A. Chen, D. M. Shin, L. Davis, and P. A. S. Johnstone, “Concurrent platinum-based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base,” Head and Neck, vol. 30, no. 3, pp. 327–335, 2008.
[60]
P. McCulloch, D. G. Altman, W. B. Campbell et al., “No surgical innovation without evaluation: the IDEAL recommendations,” The Lancet, vol. 374, no. 9695, pp. 1105–1112, 2009.
[61]
N. Agrawal, M. J. Frederick, C. R. Pickering et al., “Exome sequencing of head and neck squamous cell carcinoma reveals inactivating mutations in NOTCH1,” Science, vol. 333, no. 6046, pp. 1154–1157, 2011.
[62]
N. Stransky, A. M. Egloff, A. D. Tward et al., “The mutational landscape of head and neck squamous cell carcinoma,” Science, vol. 333, no. 6046, pp. 1157–1160, 2011.
