Fewer gastrostomies after TORS than after chemo in patients with oropharyngeal cancer

Last Updated: 2016-07-01

By Will Boggs MD

NEW YORK (Reuters Health) - Gastrostomy rates in patients with oropharyngeal cancer are significantly lower after transoral robotic surgery (TORS) than after chemoradiotherapy in the short term, according to a new study.

Nonsurgical treatments of oropharyngeal squamous cell carcinoma (OPSCC) are associated with improved swallowing and quality of life compared with traditional, open surgery, although these outcomes seem to be worse compared with those for TORS.

Dr. Eduardo Mendez from the University of Washington, Seattle, and colleagues compared survival and gastrostomy rates between 39 patients with OPSCC treated with TORS-based therapy and 88 stage-matched patients treated with radiotherapy/chemoradiotherapy.

During a median follow-up of 18 months, there were nine recurrences and eight deaths in the nonsurgical group, compared with two recurrences and no deaths in the TORS group, which translated into a clinically meaningful but statistically insignificant inverse association between TORS and mortality.

Significantly more patients in the nonsurgical group (84.1%) than in the TORS group (33.3%) had a gastrostomy tube in place at some point after treatment, according to study, online June 23 in JAMA Otolaryngology-Head & Neck Surgery.

The difference in gastrostomy tube prevalence between groups decreased over time and was no longer significant at 12 months.

"This study provides evidence among T stage-matched patients that the use of TORS-based therapy for OPSCC could yield improvements in swallowing while offering survival outcomes that are comparable to those with nonsurgical therapy," the researchers conclude.

"Continued research that evaluates OPSCC treatment algorithms, such as deintensification of adjuvant therapy and patient selection for TORS, will provide further information about optimizing functional outcomes while preserving survival for patients with these malignant neoplasms," they add.

Dr. Raymond Chai, a head and neck surgical oncologist at Mount Sinai Beth Israel, New York City, told Reuters Health by email, "The presumed advantage of TORS for oropharyngeal cancer is to maximize functional outcomes while preserving survival. However, there are only a few papers in the literature directly comparing these two modalities. This is the first paper in the literature to use matched patients, power calculations, and multivariate analysis to attempt to answer this question."

"Results of the study further support the hypothesis that the use of TORS for oropharyngeal cancer can reduce toxicity while preserving oncologic outcomes," concluded Dr. Chai, who was not involved in the research.

Dr. Mendez did not respond to a request for comments.

SOURCE: http://bit.ly/297HK5q

JAMA Otolaryngol Head Neck Surg 2016.