2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

TABLE II. Pathologic Information.

TORS alone

Adjuvant RT

Adjuvant CRT

P Value

pT

.36

T1 T2

8 (61.5%)

13 (43.3%) 17 (56.7%)

22 (32.8%) 38 (56.7%)

5 (38.5%)

T3

0 (0.0%)

0 (0.0%)

5 (7.5%)

T4

0 (0.0%)

0 (0.0%)

2 (3.0%)

pN

< .0001*

N0

7 (53.8%)

3 (10.7%)

5 (7.7%)

N1 N2

4 (30.8%) 2 (15.4%)

4 (14.3%)

6 (9.2%)

21 (75.0%)

48 (73.9%)

N3

0 (0.0%)

0 (0.0%)

6 (9.2%)

Tumor site

.50

BOT

4 (30.8%)

6 (19.4%)

9 (13.4%)

Tonsil

7 (53.9%)

23 (74.2%)

49 (73.1%)

Tonsil and BOT

0 (0.0%) 1 (7.7%)

1 (3.2%) 0 (0.0%)

4 (6.0%) 1 (1.5%)

Oropharynx

Other †

1 (7.7%)

1 (3.2%)

4 (6.0%)

HPV

.53

Positive

7 (63.6%)

23 (76.7%)

46 (79.3%)

Negative

4 (36.4%)

7 (23.3%)

12 (20.7%)

p16

.15

Positive

9 (69.2%)

27 (90.0%)

52 (89.7%)

Negative

4 (30.8%)

3 (10.0%)

6 (10.3%)

Lymphovascular invasion

.06

Positive

0 (0.0%)

10 (43.5%)

24 (38.1%)

Negative

9 (100.0%)

13 (56.5%)

39 (61.9%)

No. of lymph nodes Positive

< .0001 ‡

0 (0–1)

1 (1-2)

2 (1–3)

Total

29 (18–34)

29 (18–41)

30 (23–43)

.49

Margin §

.71

Positive

0 (0.0%)

0 (0.0%)

3 (5.7%)

Negative

13 (100.0%)

29 (100.0%)

50 (94.3%)

.0010 #

ECS

Positive

0 (0.0%)

4 (13.8%)

27 (42.9%)

Negative

12 (100.0%)

25 (86.2%)

36 (57.1%)

Certain data points could not be obtained via chart review for patients within each group contributing to a discrepancy in the total number of patients reported for each variable. Data are reported as number (%) or median (interquartile range: 25th percentile–75th percentile). *A greater proportion of those in the adjuvant RT and adjuvant CRT groups had N2/N3 staging compared to TORS alone (75% and 83% vs. 15%). † Other sites included BOT and pharynx, BOT and oropharynx (adjacent to tonsil), tonsil and pharynx, superior pole of tonsil, glossotonsillar sulcus, tonsil and neck. ‡ Those in the adjuvant RT and adjuvant CRT group had greater number of positive lymph nodes than those with TORS alone ( P < .01 for both compari- sons). There is not a statistically significant difference in positive lymph nodes between adjuvant CRT and adjuvant RT ( P 5 .07). § Based on control margin biopsy and/or re-excision. # A greater proportion of those in the adjuvant CRT had positive ECS compared to TORS alone and adjuvant RT (43% vs. 0% and 14%). BOT 5 base of tongue; CRT 5 chemoradiation therapy; ECS 5 extracapsular spread; HPV 5 human papillomavirus; p16 5 protein p16INKa; pN 5 pathological node classification; pT 5 pathological tumor classification; RT 5 radiation therapy; TORS 5 transoral robotic surgery.

by a median time to placement of 65 and 51 days for adju- vant RT and CRT, respectively; most were removed shortly after completion of adjuvant treatment, supported by a median duration of 95 and 166 days for adjuvant RT and CRT, respectively. Thus, the majority of patients received PEG placement prophylactically as recommended by their radiation oncologist or as a direct result of dysphagia due to adjuvant therapy.

thrush than TORS alone (Table IV). Adjuvant CRT was also associated with greater PEG tube dependence, espe- cially at 3 and 6 months (Table V). Although many patients in this study received PEG placement, it is important to note that the total number of patients with PEG dependence greatly diminished from 3 to 12 months. Most PEG tubes were placed around the beginning of the adjuvant treatment period, as evidenced

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Sethia et al.: QOL Outcomes of TORS for Oropharyngeal Cancer

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