Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_23_2550 - Outcomes for oropharyngeal squamous cell carcinoma (OPSCC) following transoral robotic surgery (TORS)

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Outcomes for oropharyngeal squamous cell carcinoma (OPSCC) following transoral robotic surgery (TORS)
H. H. Chao, C. A. Schonewolf, J. N. Lukens, S. D. Swisher-McClure, A. Fotouhi Ghiam, and A. Lin; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA

Purpose/Objective(s): TORS resection for head and neck squamous cell carcinoma is increasingly used in light of the morbidity associated with conventional surgical techniques. This technique has been employed in OPSCC, either as single modality treatment or in conjunction with adjuvant treatments. However, the long-term outcomes of TORS are less mature compared to other treatment modalities, including chemoradiation. There remains a need to investigate the predictors of survival and recurrence following TORS resection. This study presents the outcomes on the largest reported series to date of TORS for oropharyngeal squamous cell carcinoma (SCC).

Materials/Methods: We evaluated 474 consecutive patients who underwent TORS resection for OPSCC between 2008 – 2016 within our health system. Overall survival (OS) and locoregional relapse-free survival (LRFS) were measured from the date of surgery and assessed by Kaplan-Meier analysis. A Cox proportional hazards regression analysis was used to determine clinical predictors of OS and LRFS. Differences were considered statistically significant if the two-sided P value was less than 0.05. All analyses were performed using R statistical software (R version 3.4.2).

Results: Median follow-up was 3.4 years (range 1 day – 7.3 years). 144 patients (30.0%) received TORS resection alone, 330 patients (70.0%) received post-operative RT, and 154 patients (32.5%) received adjuvant chemoradiation. Median package time from the date of surgery to the completion of RT was 14.3 weeks. 3 and 5-year OS were 94.0% (95% CI 91.7% - 96.3%) and 89.9% (95% CI 86.2% - 93.8%) respectively. 3 and 5-year LRFS were 88.8% (95% CI 85.8% - 92.0%) and 86.6% (95% CI 83.0% – 90.3%) respectively. Overall TMN stage based on AJCC 7th Edition were 7.4% Stage I, 6.8% Stage II, 17.9% Stage III, 65.6% Stage IVA, and 1.9% Stage IVB. 424 patients (89.5%) were p16+ and 50 (10.5%) were p16-. A negative margin was identified in 365 patients (77.0%) a close margin (<=2mm) in 79 patients (16.7%) and a positive margin in 25 patients (5.3%). Positive/close margins (p = 0.03) and increased number of neck levels involved (p = 0.014) were significantly associated with worse LRFS. On multivariate analysis, only margin status (HR 1.59, 95%CI 1.05 – 2.39, p=0.027) remained associated with LRFS. Predictors for OS on multivariate analysis included margin status (HR 1.84, 95%CI 1.14 – 2.95, p = 0.012) and PNI (HR 2.45, 95%CI 1.18 – 5.06, p = 0.016).

Conclusion: In this largest series of TORS outcomes for OPSCC to date, we find excellent oncologic outcomes. Margin status is a critical surgical outcome that predicted for both LRFS and OS in our cohort. Continued investigation is necessary in order to appropriately risk stratify patients, correlate findings according to the updated AJCC 8th Edition Staging, and assess cost-effectiveness of TORS-based treatment compared to other approaches.

Author Disclosure: H. Chao: None. C.A. Schonewolf: None. J.N. Lukens: None. S.D. Swisher-McClure: None. A. Fotouhi Ghiam: None. A. Lin: Employee; Children's Hospital of Philadelphia. Consultant; Elekta.

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