Transoral laser microsurgery (TLM) ± adjuvant therapy for advanced stage oropharyngeal cancer : Outcomes and prognostic factors

✍ Scribed by Jason T. Rich; Simon Milov; James S. Lewis Jr.; Wade L. Thorstad; Douglas R. Adkins; Bruce H. Haughey

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 234 KB
• Volume: 119
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20552

✦ Synopsis

Abstract

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. Laryngoscope, 2009