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MO_29_2685 - Substantial Heterogeneity Amongst Radiation Oncologists in Adjuvant Therapy Recommendations for Patients Post-Transoral Robotic Surgery: A Patterns of Care Survey

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

Substantial Heterogeneity Amongst Radiation Oncologists in Adjuvant Therapy Recommendations for Patients Post-Transoral Robotic Surgery: A Patterns of Care Survey
J. W. Snider III1, C. DeCesaris2, J. K. Molitoris3, S. R. Rice4, M. A. L. Vyfhuis5, N. Onyeuku1, A. M. Chhabra4, S. J. Feigenberg6, and K. Hatten7; 1University of Maryland School of Medicine, Baltimore, MD, 2University of Mayland Medical Center, Baltimore, MD, 3Maryland Proton Treatment Center, University of Maryland, Baltimore, MD, 4Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, 5Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 6Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 7University of Maryland School of Medicine, Annapolis, MD

Purpose/Objective(s): There remains a relative lack of consensus as to standards for adjuvant therapy following transoral robotic surgery (TORS) for oropharyngeal cancer (OPC). We hypothesized that there is significant heterogeneity in practice patterns among radiation oncologists as to therapeutic recommendations post-TORS.

Materials/Methods: An IRB-approved questionnaire was developed to survey demographics of respondents, setting of clinical practice, institutional experience with TORS, neck management with TORS, general adjuvant therapy recommendations, and respondent opinions regarding margin status, extracapsular extension (ECE), unknown primary management, and radiotherapy (RT) target/dose recommendations. Additionally, 3 clinical vignettes were presented to elicit respondent adjuvant therapy recommendations. Responses were collected through a third-party website. A Pearson’s correlation test was utilized for statistical analysis.

Results: A total of 109 radiation oncologists responded to the survey, of which 103 (94.5%) were attending/practicing physicians and 6 (5.5%) residents. Respondents practiced in a wide variety of clinical settings: major academic hospital (41.3%), non-academic hospital (27.5%), community academic site (16.5%), and private clinic (14.7%). Most (58.7%) respondents had significant institutional experience (at least 2 years) with TORS, and more than half (50.5%) saw at least 10 post-TORS patients for adjuvant therapy per year. Respondents reported using a variety of cutoffs for margin distance to be considered negative post-TORS: 0 mm 12.4%, <2 mm 5.7%, ≥2 mm 44.8%, ≥3mm 13.3%, ≥5mm 15.2%, other 8.6%. Respondents varied in their willingness to avoid RT to the primary site with negative margins and nodal disease: always treat primary 38.8%, avoid on prospective trial 36.9%, avoid off-trial 22.3%, regularly avoid 1.9%. With TORS, 44.0% reported that neck dissections were always perfomed concurrently, while others would stage dissection: large adenopathy/ECE concern (18.6%), always (16.0%), unresectable (4.0%), scheduling (9.3%), other (8.0%). Most practitioners (65.7%) did not currently use HPV-status to select patients for TORS, but 25.5% felt TORS was better suited to HPV+ disease and 8.8% to HPV- disease. Finally, in the 3 vignettes, the top response for each scenario’s clinical management was only 65.3% / 51.0% /53.1%, respectively.

Conclusion: There remains significant heterogeneity in radiation oncologists’ adjuvant therapy recommendations for post-TORS patients. Detailed practice guidelines would likely be of benefit in standardizing approaches as additional data emerges.

Author Disclosure: J.W. Snider: None. C. DeCesaris: None. J.K. Molitoris: None. S.R. Rice: None. N. Onyeuku: None. S.J. Feigenberg: None.

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