- In a randomized trial, swallowing outcomes slightly favored radiotherapy over transoral robotic surgery (TORS) with neck dissection for oropharyngeal squamous cell carcinoma (OPSCC).
- The authors note the difference was not clinically meaningful.
- Toxicity profiles differed for the 2 approaches.
Why this matters
- TORS has largely supplanted radiotherapy in the treatment of OPSCC, but the findings suggest both approaches are viable.
- Previous observational studies had favored TORS.
- Phase 2, randomized controlled ORATOR trial (n=68).
- Funding: Canadian Cancer Society, Ontario Institute for Cancer Research, Wolfe Surgical Research Professorship.
- Total mean MD Anderson Dysphagia Inventory (MDADI) scores were higher in the radiotherapy group (86.9 vs 80.1; P=.042), but the difference was not clinically meaningful (
- More patients had total oral diet with no restrictions at 1 year in the radiotherapy group (100% vs 84%; P=.055).
- The radiotherapy group reported more cases of neutropenia (18% vs 0%), hearing loss (39% vs 15%), and tinnitus (35% vs 6%). Trismus was more common in the TORS plus neck dissection group (3% vs 27%).
- Most common adverse events:
- Radiotherapy: grade 3 dysphagia (6), hearing loss (6), and mucositis (4).
- TORS: grade 3 dysphagia (9). 1 death from bleeding.
- Small sample size.