Oropharyngeal Malignancies: TORS with Adjuvant Therapy Essay

Oropharyngeal Malignancies: TORS with Adjuvant Therapy Essay

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Adjuvant Therapy
In the present study, 12 pts were advised adjuvant radiotherapy either with or without chemotherapy. TORS alongwith neck dissection allowed us to identify patients with favourable pathological features, thus allowing for deintensification of overall treatment in comparison to concurrent chemoradiation. In a similar prospective single arm study by Weinstein et al.,25 ipsilateral SND at the time of TORS for primary oropharyngeal carcinoma allowed to "deintensify’’ adjuvant therapy (postoperative chemoradiation) in many pts. Weinstein et al.26 had pointed out that while most patients in the study had advanced clinical stage, almost all of them were found to have favourable pathologic features as well as pathologic down-staging at both the primary site and the neck, which allowed for de-escalation of the overall treatment. More et al.27 reported lower swallowing dysfunction with the lower-dose or deintensified adjuvant radiotherapy in patients undergoing TORS followed by adjuvant radiotherapy in comparison to CRT for advanced oropharyngeal malignancies. In conclusion, while this study data supports deintensification of treatment for oropharyngeal carcinomas, further investigation would be valuable to allow these results to be generalized.

Functional Outcome
Swallowing Function, Ryles tube use and PEG Dependence
Another measure of interest in this study was functional outcome. The function most at risk with oropharyngeal disease progression or treatment is swallowing. One of the most commonly used surrogate indicators of preservation of swallowing function in our study was Ryle’s tube use and PEG dependency. PEG insertion was done in 2 (5%) previously irradiated pts and was removed after a duration of 30 days. Thus...

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...hown to have acceptable limited morbidity with an unexpected benefit in terms of speech and swallowing function. Rates of positive surgical margins were at least equivalent to those reported for other surgical modalities. Limitations of the study include nonrandomization of our patients, small number of pt cohort and a short follow up period. Additionally, objective swallowing and speech assessment studies were not done in our study. Instead, we relied on PEG tube dependency, duration of Ryle’s tube use and tracheostomy dependence as surrogates for functional outcomes. Yet, this study represents a unique single institution study experience in India with TORS. We hope that the promising results from our study can serve as a treatment arm for comparisons in future prospective randomized trials examining the role of robotic surgery for treating head and neck cancers.

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