Advertisement

Is There a New Role for Surgery in Oropharynx Cancer?

  • Yann Litzistorf
  • Christian SimonEmail author
Chapter

Abstract

Oropharyngeal cancer (OPC) has long been considered a disease that should be treated with radiation therapy or chemoradiation. An ever-increasing understanding and appreciation of the course of these patients with respect to the development and treatment of e.g. secondary primary malignancies (SPM), the evolution of novel surgical techniques, and the changing epidemiology of oropharyngeal cancers however seems to imply a change of this paradigm. Patients with early stage OPCs run the risk of developing SPMs and previous treatment may impact on the success of treating SPMs. Patients with advanced stage OPCs have nowadays numerous function-preserving (i.e. transoral surgery) and function-recovering (i.e. microvascular free flap procedures) surgical procedures available to them. HPV-positive OPCs have a better prognosis, but care must be taken to only choose low-risk patients for de-escalation treatments, and surgery can help given it provides immediate pathological risk-stratification. Finally, recurrent OPCs are more and more derived from HPV-positive disease resulting in a much better prognosis and thus providing the rational and incentive to be more aggressive in terms of salvage procedures. Prospective clinical trials will have to prove in the future the role of these novel surgical techniques and how they compare to modern non-surgical treatment modalities for the treatment of OPCs.

Keywords

Oropharynx Cancer Recurrent Human papillomavirus HPV p16 Transoral robotic surgery Transoral Robotic Surgery TOS De-intensification Second primary malignancy 

References

  1. 1.
    Holsinger FC, Sweeney AD, Jantharapattana K, Salem A, Weber RS, Chung WY, et al. The emergence of endoscopic head and neck surgery. Curr Oncol Rep. 2010;12(3):216–22.  https://doi.org/10.1007/s11912-010-0097-0.CrossRefPubMedGoogle Scholar
  2. 2.
    Pierre CS, Dassonville O, Chamorey E, Poissonnet G, Riss JC, Ettaiche M, et al. Long-term functional outcomes and quality of life after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer. Acta Otolaryngol. 2014;134(10):1086–93.  https://doi.org/10.3109/00016489.2014.913809.CrossRefPubMedGoogle Scholar
  3. 3.
    Broome M, Juilland N, Litzistorf Y, Monnier Y, Sandu K, Pasche P, et al. Factors influencing the incidence of severe complications in head and neck free flap reconstructions. Plast Reconstr Surg Glob Open. 2016;4(10):e1013.  https://doi.org/10.1097/GOX.0000000000001013.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol. 2015.  https://doi.org/10.1245/s10434-015-4386-6.CrossRefGoogle Scholar
  5. 5.
    Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29(32):4294–301.  https://doi.org/10.1200/JCO.2011.36.4596.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24–35.  https://doi.org/10.1056/NEJMoa0912217.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Parsons JT, Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Villaret DB, et al. Squamous cell carcinoma of the oropharynx: surgery, radiation therapy, or both. Cancer. 2002;94(11):2967–80.CrossRefGoogle Scholar
  8. 8.
    Mantsopoulos K, Psychogios G, Waldfahrer F, Zenk J, Iro H. Surgical treatment of locally limited tonsillar cancer. Surg Oncol. 2012;21(1):e13–6.  https://doi.org/10.1016/j.suronc.2011.10.003.CrossRefPubMedGoogle Scholar
  9. 9.
    Steiner W, Fierek O, Ambrosch P, Hommerich CP, Kron M. Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue. Arch Otolaryngol Head Neck Surg. 2003;129(1):36–43.CrossRefGoogle Scholar
  10. 10.
    Williams CE, Kinshuck AJ, Derbyshire SG, Upile N, Tandon S, Roland NJ, et al. Transoral laser resection versus lip-split mandibulotomy in the management of oropharyngeal squamous cell carcinoma (OPSCC): a case match study. Eur Arch Otorhinolaryngol. 2014;271(2):367–72.  https://doi.org/10.1007/s00405-013-2501-5.CrossRefPubMedGoogle Scholar
  11. 11.
    Weinstein GS, O’Malley BW Jr, Cohen MA, Quon H. Transoral robotic surgery for advanced oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2010;136(11):1079–85.  https://doi.org/10.1001/archoto.2010.191.CrossRefPubMedGoogle Scholar
  12. 12.
    Mattheis S, Hasskamp P, Holtmann L, Schafer C, Geisthoff U, Dominas N, et al. Flex Robotic System in transoral robotic surgery: the first 40 patients. Head Neck. 2017;39(3):471–5.  https://doi.org/10.1002/hed.24611.CrossRefPubMedGoogle Scholar
  13. 13.
    Lang S, Mattheis S, Hasskamp P, Lawson G, Guldner C, Mandapathil M, et al. A European multicenter study evaluating the flex robotic system in transoral robotic surgery. Laryngoscope. 2017;127(2):391–5.  https://doi.org/10.1002/lary.26358.CrossRefPubMedGoogle Scholar
  14. 14.
    Monnier Y, Simon C. Surgery versus radiotherapy for early oropharyngeal tumors: a never-ending debate. Curr Treat Options in Oncol. 2015;16(9):42.  https://doi.org/10.1007/s11864-015-0362-4.CrossRefGoogle Scholar
  15. 15.
    Ishimaru M, Ono S, Suzuki S, Matsui H, Fushimi K, Yasunaga H. Risk factors for free flap failure in 2,846 patients with head and neck cancer: a national database study in Japan. J Oral Maxillofac Surg. 2016;74(6):1265–70.  https://doi.org/10.1016/j.joms.2016.01.009.CrossRefPubMedGoogle Scholar
  16. 16.
    Wong AK, Joanna Nguyen T, Peric M, Shahabi A, Vidar EN, Hwang BH, et al. Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery. 2015;35(1):6–12.  https://doi.org/10.1002/micr.22223.CrossRefPubMedGoogle Scholar
  17. 17.
    Schultz BD, Sosin M, Nam A, Mohan R, Zhang P, Khalifian S, et al. Classification of mandible defects and algorithm for microvascular reconstruction. Plast Reconstr Surg. 2015;135(4):743e–54e.  https://doi.org/10.1097/prs.0000000000001106.CrossRefPubMedGoogle Scholar
  18. 18.
    Steinbacher DM. Three-dimensional analysis and surgical planning in craniomaxillofacial surgery. J Oral Maxillofac Surg. 2015;73(12 Suppl):S40–56.  https://doi.org/10.1016/j.joms.2015.04.038.CrossRefPubMedGoogle Scholar
  19. 19.
    Morisod B, Simon C. Meta-analysis on survival of patients treated with transoral surgery versus radiotherapy for early-stage squamous cell carcinoma of the oropharynx. Head Neck. 2016;38(Suppl 1):E2143–50.  https://doi.org/10.1002/hed.23995.CrossRefPubMedGoogle Scholar
  20. 20.
    Gan SJ, Dahlstrom KR, Peck BW, Caywood W, Li G, Wei Q, et al. Incidence and pattern of second primary malignancies in patients with index oropharyngeal cancers versus index nonoropharyngeal head and neck cancers. Cancer. 2013;119(14):2593–601.  https://doi.org/10.1002/cncr.28107.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cerezo L, Lopez C, de la Torre A, Suarez D, Hervas A, Ruiz A, et al. Incidence of human papillomavirus-related oropharyngeal cancer and outcomes after chemoradiation in a population of heavy smokers. Head Neck. 2014;36(6):782–6.  https://doi.org/10.1002/hed.23366.CrossRefPubMedGoogle Scholar
  22. 22.
    Low TH, Yeh D, Zhang T, Araslanova R, Hammond JA, Palma D, et al. Evaluating organ preservation outcome as treatment endpoint for T1aN0 glottic cancer. Laryngoscope. 2017;127(6):1322–7.  https://doi.org/10.1002/lary.26317.CrossRefPubMedGoogle Scholar
  23. 23.
    Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350(19):1945–52.CrossRefGoogle Scholar
  24. 24.
    Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–44.CrossRefGoogle Scholar
  25. 25.
    Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005;27(10):843–50.  https://doi.org/10.1002/hed.20279.CrossRefPubMedGoogle Scholar
  26. 26.
    Harari PM, Harris J, Kies MS, Myers JN, Jordan RC, Gillison ML, et al. Postoperative chemoradiotherapy and cetuximab for high-risk squamous cell carcinoma of the head and neck: Radiation Therapy Oncology Group RTOG-0234. J Clin Oncol. 2014;32(23):2486–95.  https://doi.org/10.1200/jco.2013.53.9163.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kimple RJ, Smith MA, Blitzer GC, Torres AD, Martin JA, Yang RZ, et al. Enhanced radiation sensitivity in HPV-positive head and neck cancer. Cancer Res. 2013;73(15):4791–800.  https://doi.org/10.1158/0008-5472.CAN-13-0587.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Huang SH, Xu W, Waldron J, Siu L, Shen X, Tong L, et al. Refining American Joint Committee on Cancer/Union for International Cancer Control TNM stage and prognostic groups for human papillomavirus-related oropharyngeal carcinomas. J Clin Oncol. 2015;33(8):836–45.  https://doi.org/10.1200/jco.2014.58.6412.CrossRefPubMedGoogle Scholar
  29. 29.
    Goepfert RP, Lewin JS, Barrow MP, Gunn GB, Fuller CD, Beadle BM, et al. Long-term, prospective performance of the MD anderson dysphagia inventory in “low-intermediate risk” oropharyngeal carcinoma after intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2017;97(4):700–8.  https://doi.org/10.1016/j.ijrobp.2016.06.010.CrossRefPubMedGoogle Scholar
  30. 30.
    Choby GW, Kim J, Ling DC, Abberbock S, Mandal R, Kim S et al. Transoral robotic surgery alone for oropharyngeal cancer: quality-of-life outcomes. JAMA Otolaryngol Head Neck Surg. 2015;  https://doi.org/10.1001/jamaoto.2015.0347.CrossRefGoogle Scholar
  31. 31.
    More YI, Tsue TT, Girod DA, Harbison J, Sykes KJ, Williams C, et al. Functional swallowing outcomes following transoral robotic surgery vs primary chemoradiotherapy in patients with advanced-stage oropharynx and supraglottis cancers. JAMA Otolaryngol Head Neck Surg. 2013;139(1):43–8.  https://doi.org/10.1001/jamaoto.2013.1074.CrossRefPubMedGoogle Scholar
  32. 32.
    Holsinger FC, Ferris RL. Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and clinical trials. J Clin Oncol. 2015;33(29):3285–92.  https://doi.org/10.1200/jco.2015.62.3157.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Sinha P, Patrik P, Thorstad WL, Gay HA, Haughey BH. Does elimination of planned postoperative radiation to the primary bed in p16-positive, transorally-resected oropharyngeal carcinoma associate with poorer outcomes? Oral Oncol. 2016;61:127–34.  https://doi.org/10.1016/j.oraloncology.2016.08.013.CrossRefPubMedGoogle Scholar
  34. 34.
    Chin RI, Rao YJ, Hwang MY, Spencer CR, Pierro M, DeWees T et al. Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer. 2017.  https://doi.org/10.1002/cncr.30931CrossRefGoogle Scholar
  35. 35.
    Jayaram SC, Muzaffar SJ, Ahmed I, Dhanda J, Paleri V, Mehanna H. Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: a systematic review and meta-analysis. Head Neck. 2016;38(12):1855–61.  https://doi.org/10.1002/hed.24531.CrossRefPubMedGoogle Scholar
  36. 36.
    Fakhry C, Zhang Q, Nguyen-Tan PF, Rosenthal D, El-Naggar A, Garden AS, et al. Human papillomavirus and overall survival after progression of oropharyngeal squamous cell carcinoma. J Clin Oncol. 2014;32(30):3365–73.  https://doi.org/10.1200/jco.2014.55.1937.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.CHUVLausanneSwitzerland

Personalised recommendations