Trans oral robotic surgery versus definitive chemoradiotherapy for oropharyngeal cancer: 10-year institutional experience

Trans Oral Robotic Surgery (TORS) is a fascinating new technique that has proved to be a safe and feasible treatment of oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to compare oncological outcomes of OPSCC-patients treated with either TORS (with or without adjuvant therapy) or definitive chemoradiation therapy (CRT).

This study involved 129 patients with OPSCC, treated with TORS or definitive CRT at our Department between 2008 and 2018. Clinicopathological characteristics, treatment specifications and oncological outcomes were evaluated retrospectively.

Definitive CRT was administered in 69 patients (53,5%), while 60 (46,5%) were surgically treated with TORS alone or in combination with adjuvant therapy. Patients who underwent adjuvant therapy after TORS received a lower dosages of cisplatin and radiation than the CRT group (p < 0.01). There was no statistical difference in 5-year survival rate and in disease free interval between TORS and CRT groups. Albeit 5-year overall survival in the HPV-related tumours was better, the HPV status did not affect the rate of local and regional recurrence. Treatment groups (TORS vs. CRT) were not found affecting survivals on multivariate analysis. Tube feeding dependency rate was low between both groups (1.7% in TORS vs. 4.8% in CRT groups).

The modern management of OPSCC must be tailored to each patient. Although the definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of single therapeutic strategy requires an evaluation by a multidisciplinary team.