Conversion TORS after neoadjuvant immunotherapy for advanced BOT-SCC: a retrospective study.

Area of Science:

• Oncology
• Surgical Oncology
• Robotic Surgery

Background:

• Advanced base-of-tongue squamous cell carcinoma (BOT-SCC) traditionally poses challenges for transoral resection due to deep invasion and margin difficulties.
• Transoral robotic surgery (TORS) offers potential for minimally invasive treatment but has been limited in advanced BOT-SCC cases.

Purpose of the Study:

• To evaluate the efficacy of neoadjuvant therapy in enabling TORS for patients with advanced BOT-SCC.
• To assess perioperative outcomes, functional recovery, and oncologic control following neoadjuvant therapy and TORS.

Main Methods:

• Retrospective analysis of nine patients with advanced BOT-SCC (stage ≥T4N2bM0).
• Patients received three cycles of neoadjuvant pembrolizumab followed by TORS and neck dissection.
• Evaluated radiologic response, tumor shrinkage, operative metrics, complications (Clavien-Dindo), and functional outcomes (MDADI, FOIS, GRBAS).

Main Results:

• Neoadjuvant therapy resulted in significant tumor downstaging, with 66.7% partial response and a mean tumor reduction of 35.6%.
• All patients achieved R0 resection with acceptable operative times and minimal blood loss.
• Tumor shrinkage correlated inversely with operative time and blood loss; functional outcomes at 3 months were favorable with no major complications.

Conclusions:

• Neoadjuvant therapy can make select patients with advanced BOT-SCC candidates for TORS, facilitating oncologically sound resection.
• This approach demonstrated low perioperative morbidity and promising early functional recovery.
• Further prospective studies are needed to refine patient selection and explore biomarker-guided de-intensification strategies.