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Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis

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Abstract

Purpose

To perform a meta-analysis evaluating trans-oral robotic surgery (TORS), and intensity-modulated radiation therapy (IMRT) in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).

Methods

This study adhered to the PRISMA guidelines.

Results

A total of 5624 patients (IMRT, n = 4322; TORS, n = 1302) were included in this meta-analysis. The majority of patients in the IMRT cohort were treated with concurrent CT (n = 3433, 81.3%). On the other hand, the majority of patients in the TORS cohort was treated with an adjuvant treatment (n = 826, 67.8%). IMRT subgroup showed a cumulative survival rate of 83.6% (99% CI 76.9–89.3%), while it was 91.3% (99% CI 81.2–97.8%) in the TORS subgroup. Disease-free survival was significantly different between IMRT (79.6%, 99% CI 70.6–87.3%), and TORS (89.4%, 99% CI 82.7–94.5%). IMRT subgroup showed a feeding tube dependence rate of 4.0% (99% CI 1.1–8.4%), but it was not significantly different from the TORS subgroup (1.3%, 99% CI 0–4.9%). Tracheostomy dependence rates were similar among the two subgroups (IMRT, 0.7%, 99% CI 0–1.1%; TORS, 0.2%, 99% CI 0–1.1%).

Conclusions

TORS appears to be a consolidated effective surgical approach in the management of OPSCC, according to both oncologic and functional outcomes. Further RCTs comparing TORS and IMRT with homogeneous cohorts in terms of tumor staging and HPV status are advisable.

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Data and material are available on request.

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Authors and Affiliations

  1. Otorhinolaryngology Unit, IRCCS Humanitas Clinical and Research Centre, Via Manzoni 56, 20089, Rozzano, MI, Italy

    Armando De Virgilio, Andrea Costantino, Giuseppe Mercante, Fabio Ferreli, Luca Malvezzi, Giovanni Colombo, Giovanni Cugini & Giuseppe Spriano

  2. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy

    Armando De Virgilio, Andrea Costantino, Giuseppe Mercante & Giuseppe Spriano

  3. Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy

    Raul Pellini & Gerardo Petruzzi

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  1. Armando De Virgilio
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Contributions

ADV contributed to study design, data analysis, manuscript development, review of final manuscript. AC contributed to study design, data collection, and analysis, manuscript development, review of final manuscript. GM contributed to study design, review of final manuscript. RP contributed to supervision, review of final manuscript. FF contributed to data collection, review of final manuscript. LM contributed to study design, review of final manuscript. GC contributed to data analysis, review of final manuscript. GC contributed to data collection, review of final manuscript. GP contributed to data analysis, review of final manuscript. GS contributed to supervision, study design, review of final manuscript.

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Correspondence to Andrea Costantino.

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De Virgilio, A., Costantino, A., Mercante, G. et al. Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 278, 1321–1335 (2021). https://doi.org/10.1007/s00405-020-06224-z

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