OBJECTIVES/HYPOTHESIS: To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer. DATA SOURCES: The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012. METHODS: Studies included patients treated for early T-stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment- specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised. RESULTS: Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)-and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge. CONCLUSION: This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events.
OBJECTIVES/HYPOTHESIS: To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer. DATA SOURCES: The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012. METHODS: Studies included patients treated for early T-stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment- specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised. RESULTS: Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)-and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge. CONCLUSION: This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events.
Authors: William R Kennedy; Michael P Herman; Rohan L Deraniyagala; Robert J Amdur; John W Werning; Peter Dziegielewski; Jessica Kirwan; Christopher G Morris; William M Mendenhall Journal: Eur Arch Otorhinolaryngol Date: 2016-04-08 Impact factor: 2.503
Authors: Axel Sahovaler; David E Eibling; Ida Bruni; Uma Duvvuri; S Danielle MacNeil; Anthony C Nichols; John Yoo; Kevin Fung; Kathryn Roth Journal: J Robot Surg Date: 2019-01-23
Authors: Arun Sharma; Sapna Patel; Fred M Baik; Grant Mathison; Brendan H G Pierce; Samir S Khariwala; Bevan Yueh; Stephen M Schwartz; Eduardo Méndez Journal: JAMA Otolaryngol Head Neck Surg Date: 2016-07-01 Impact factor: 6.223