Is There a New Role for Surgery in Oropharynx Cancer?
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.
KeywordsOropharynx Cancer Recurrent Human papillomavirus HPV p16 Transoral robotic surgery Transoral Robotic Surgery TOS De-intensification Second primary malignancy
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