Oropharynx SCC: TORS, radiotherapy yield similar QoL in randomized trial

  • Lancet Oncol

  • curated by Jim Kling
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Study design

  • Phase 2, randomized controlled ORATOR trial (n=68).
  • Funding: Canadian Cancer Society, Ontario Institute for Cancer Research, Wolfe Surgical Research Professorship.

Key results

  • 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.

Limitations

  • Small sample size.