Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status

Niclas Rubek; Hani Ibrahim Channir; Birgitte Wittenborg Charabi; Christel Bræmer Lajer; Katalin Kiss; Hans Ulrik Nielsen; Jens Bentzen; Jeppe Friborg; Christian von Buchwald

doi:10.1007/s00405-016-4433-3

Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status

Niclas Rubek^*, Hani Ibrahim Channir, Birgitte Wittenborg Charabi, Christel Bræmer Lajer, Katalin Kiss, Hans Ulrik Nielsen, Jens Bentzen, Jeppe Friborg, Christian von Buchwald

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

14 Citationer (Scopus)

Abstract

There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.

Originalsprog	Engelsk
Tidsskrift	European Archives of Oto-Rhino-Laryngology
Vol/bind	274
Udgave nummer	5
Sider (fra-til)	2229-2237
ISSN	0937-4477
DOI	https://doi.org/10.1007/s00405-016-4433-3
Status	Udgivet - 2017

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10.1007/s00405-016-4433-3

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Citationsformater

Rubek, N., Channir, H. I., Charabi, B. W., Lajer, C. B., Kiss, K., Nielsen, H. U., Bentzen, J., Friborg, J., & von Buchwald, C. (2017). Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. European Archives of Oto-Rhino-Laryngology, 274(5), 2229-2237. https://doi.org/10.1007/s00405-016-4433-3

Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. / Rubek, Niclas; Channir, Hani Ibrahim; Charabi, Birgitte Wittenborg et al.
I: European Archives of Oto-Rhino-Laryngology, Bind 274, Nr. 5, 2017, s. 2229-2237.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Rubek, N, Channir, HI, Charabi, BW, Lajer, CB, Kiss, K, Nielsen, HU, Bentzen, J, Friborg, J & von Buchwald, C 2017, 'Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status', European Archives of Oto-Rhino-Laryngology, bind 274, nr. 5, s. 2229-2237. https://doi.org/10.1007/s00405-016-4433-3

Rubek N, Channir HI, Charabi BW, Lajer CB, Kiss K, Nielsen HU et al. Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status. European Archives of Oto-Rhino-Laryngology. 2017;274(5):2229-2237. doi: 10.1007/s00405-016-4433-3

Rubek, Niclas ; Channir, Hani Ibrahim ; Charabi, Birgitte Wittenborg et al. / Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center : a phase II trial on feasibility and tumour margin status. I: European Archives of Oto-Rhino-Laryngology. 2017 ; Bind 274, Nr. 5. s. 2229-2237.

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title = "Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center: a phase II trial on feasibility and tumour margin status",

abstract = "There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.",

keywords = "Human papillomavirus, Margin status, Oropharyngeal squamous cell carcinoma, Prospective trial, Transoral robotic surgery",

author = "Niclas Rubek and Channir, {Hani Ibrahim} and Charabi, {Birgitte Wittenborg} and Lajer, {Christel Br{\ae}mer} and Katalin Kiss and Nielsen, {Hans Ulrik} and Jens Bentzen and Jeppe Friborg and {von Buchwald}, Christian",

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doi = "10.1007/s00405-016-4433-3",

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T1 - Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center

T2 - a phase II trial on feasibility and tumour margin status

AU - Rubek, Niclas

AU - Channir, Hani Ibrahim

AU - Charabi, Birgitte Wittenborg

AU - Lajer, Christel Bræmer

AU - Kiss, Katalin

AU - Nielsen, Hans Ulrik

AU - Bentzen, Jens

AU - Friborg, Jeppe

AU - von Buchwald, Christian

PY - 2017

Y1 - 2017

N2 - There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.

AB - There is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) in the western world due to human papillomavirus (HPV). According to the Danish Head and Neck Cancer Group guidelines, the current recommended treatment of patients with OPSCC in Denmark is primary radiation therapy (RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September 2014 and January 2016, 30 consecutive patients with clinical T1–T2, N0–N1 OPSCC underwent primary TORS and concurrent neck dissection. The patients were offered postoperative adjuvant therapy according to pathological risk parameters: pT >2, T-site margin <2 mm, pN >1 or extracapsular extension (ECE). Concomitant chemotherapy was offered to patients with the presence of ECE or involved margins. Twenty-nine patients had negative margins on T-site after primary resection. Only one patient had a close margin of 1 mm. Unilateral neck dissection was performed in 21 patients while nine patients underwent bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may be an alternative to primary RT and CCR in a selected group of patients with early stage OPSCC.

KW - Human papillomavirus

KW - Margin status

KW - Oropharyngeal squamous cell carcinoma

KW - Prospective trial

KW - Transoral robotic surgery

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DO - 10.1007/s00405-016-4433-3

M3 - Journal article

C2 - 28050651

AN - SCOPUS:85008199371

SN - 0937-4477

VL - 274

SP - 2229

EP - 2237

JO - European Archives of Oto-Rhino-Laryngology

JF - European Archives of Oto-Rhino-Laryngology

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