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A New Clinical Trial of Neoadjuvant Chemotherapy Combined With Transoral Robotic Surgery and Customized Adjuvant Therapy for Patients With T3 or T4 Oropharyngeal Cancer

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A prospective clinical trial of combination neoadjuvant chemotherapy, transoral robotic surgery (TORS), and customized adjuvant therapy for patients with locally advanced oropharyngeal cancer was conducted.

Methods

Between July 2009 and October 2016, 31 patients were enrolled in this clinical trial.

Results

The primary lesions were located in the tonsils of 27 patients and in the base of the tongue of 4 patients. Of the 31 patients, 16 (51.6%) were classified as T3 and 15 patients (48.4%) as T4a. Three patients (9.7%) had stage 3 disease, and 28 (90.3%) had stage 4 disease. The 5-year overall survival rate was 78.7%; the 5-year disease-specific survival rate was 85%; and the 5-year disease-free survival rate was 80.8%. At the final follow-up visit, 26 patients were alive with no evidence of disease, and 1 was alive with disease. Four patients died during the study: two of tumor-node-metastasis (TNM)-related disease and two of another condition. All the patients tolerated an oral diet at an average of 7.4 days postoperatively. At the subjective swallowing evaluation using the Functional Outcome Swallowing Scale score, 83.9% of the patients exhibited favorable outcomes. No patient was permanently dependent on a feeding tube. All the patients breathed and phonated in the absence of a permanent tracheotomy at the final follow-up evaluation.

Conclusions

The treatment strategy in this study afforded good oncologic and functional outcomes for patients with locally advanced oropharyngeal cancer. Although future large-scale multicenter studies with longer follow-up periods are needed, this study showed that neoadjuvant chemotherapy combined with TORS is useful for treating advanced oropharyngeal cancer.

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DISCLOSURES

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea

    Young Min Park MD, PhD

  2. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea

    Chan Min Jung MD, Dongchul Cha MD, Da Hee Kim MD & Se-Heon Kim MD, PhD

  3. Department of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea

    Hye Ryun Kim MD, PhD

  4. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea

    Ki Chang Keum MD, PhD

  5. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Nam Hoon Cho MD, PhD

Authors
  1. Young Min Park MD, PhD
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  2. Chan Min Jung MD
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  3. Dongchul Cha MD
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  4. Da Hee Kim MD
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  5. Hye Ryun Kim MD, PhD
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  6. Ki Chang Keum MD, PhD
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  7. Nam Hoon Cho MD, PhD
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  8. Se-Heon Kim MD, PhD
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Corresponding author

Correspondence to Se-Heon Kim MD, PhD.

Electronic supplementary material

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10434_2017_6001_MOESM1_ESM.jpg

SUPPLEMENTAL FIG. 1 Schematic view of neoadjuvant chemotherapy plus transoral robotic surgery (TORS) for a patient with T3 tonsillar cancer. A The tumor originated from the left tonsil with tongue base invasion. B After three cycles of neoadjuvant chemotherapy, the tumor size was decreased significantly. The primary lesion was initially video-recorded via rigid or flexible endoscopy. C Resection margins (blue line) were mapped based on the pretreatment dimensions (red line) rather than the dimensions of the reduced tumors after neoadjuvant chemotherapy. D The pathologic specimen was analyzed for margin status and other adverse pathologic features. (JPEG 172 kb)

10434_2017_6001_MOESM2_ESM.jpg

SUPPLEMENTAL FIG. 2 Patient with a diagnosis of T4aN3M0 tonsillar cancer. A A huge tumor was observed in the left tonsillar fossa, and a metastatic node more than 6 cm in diameter was evident at level 2 of the left neck. B After three cycles of neoadjuvant chemotherapy, the size of the primary tumor and metastatic node was significantly decreased, and transoral robotic lateral oropharyngectomy was performed based on the initial extent of the disease with modified radical neck dissection. C The pathologic specimen was confirmed to have negative margins. The patient was alive 1 year postoperatively with no evidence of disease (JPEG 122 kb)

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Park, Y.M., Jung, C.M., Cha, D. et al. A New Clinical Trial of Neoadjuvant Chemotherapy Combined With Transoral Robotic Surgery and Customized Adjuvant Therapy for Patients With T3 or T4 Oropharyngeal Cancer. Ann Surg Oncol 24, 3424–3429 (2017). https://doi.org/10.1245/s10434-017-6001-5

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  • DOI: https://doi.org/10.1245/s10434-017-6001-5

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