title: Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma - A systematic review of the literature.
abstract: BACKGROUND
  Intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy is widely utilized for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). However, due to significant acute and late toxicities there has been increasing interest in minimally invasive surgical approaches, particularly transoral robotic surgery (TORS) in an attempt to preserve patient quality of life while maintaining oncologic outcomes. The aim of this study was to review the current literature in order to compare primary IMRT versus TORS in the management of OPSCC.
  
  
  METHODS
  A MEDLINE search was conducted to identify studies reporting on the outcomes of TORS or IMRT in the treatment of OPSCC. Reference lists were also reviewed for relevant articles. Oncologic, functional, and quality of life data is summarized and discussed.
  
  
  RESULTS
  One hundred-ninety papers were identified through the MEDLINE search. An additional 52 papers were retrieved by hand searching the reference lists. Ultimately, 44 papers were identified that discussed outcomes after IMRT or TORS for OPSCC. No outcomes from randomized trials were identified.
  
  
  CONCLUSIONS
  No randomized trials comparing TORS versus IMRT to each other were identified. Uncontrolled reports from the current literature suggest comparable oncologic outcomes with TORS compared to IMRT and functional outcomes may be superior. However, the median follow-up was relatively short and the TORS studies included patients with earlier stage OPSCC on average compared to IMRT studies. Prospective, randomized controlled trials and direct, well-matched comparisons are needed to further elucidate the role for TORS in the treatment of oropharyngeal squamous cell carcinoma.
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: D H
authors.initials: DH
authors.lastname: Yeh
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Tam
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Fung
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: S D
authors.initials: SD
authors.lastname: MacNeil
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Yoo
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada; Division of Medical Oncology, Western University, London, Ontario Canada.
authors.forename: E
authors.initials: E
authors.lastname: Winquist
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada; Division of Radiation Oncology, Western University, London, Ontario, Canada.
authors.forename: D A
authors.initials: DA
authors.lastname: Palma
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
authors.forename: A C
authors.initials: AC
authors.lastname: Nichols
mesh_terms: D019468:Disease Management; D006801:Humans; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: Oropharyngeal squamous cell carcinoma; Radiotherapy; Robotic surgery; Systematic review