title: A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review.
abstract: OBJECTIVE
  To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events.
authors.affiliation: Department of Otolaryngology-Head Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.forename: James K
authors.initials: JK
authors.lastname: Byrd
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wu
authors.forename: Chaz L
authors.initials: CL
authors.lastname: Stucken
authors.forename: Uma
authors.initials: U
authors.lastname: Duvvuri
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D009055:Mouth; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D050397:Radiotherapy, Intensity-Modulated; D012371:Robotics / Q000379:methods*
keywords: IMRT; TORS; adverse events; oropharynx cancer; outcomes; survival