title: Transoral robotic surgery and a paradigm shift in the management of oropharyngeal squamous cell carcinoma.
abstract: Efforts to improve upon oncologic results for resectable oropharyngeal carcinoma over the past 40 years have yielded many treatment options. However, the two fundamental approaches, surgical and nonsurgical, have not been compared in a randomized trial. Both approaches can be effective and both can cause treatment-related swallowing complications. Early experience combining technological advancements with conformal radiotherapy and transoral robotic surgery suggests that the risk of swallowing complications may be reduced and that treatment outcomes may be improved through pathologic stratification and risk-adapted adjuvant therapy. This may also be a valid strategy upon which treatment de-intensification may be studied for human-papillomavirus-associated oropharyngeal carcinoma due to its favorable prognosis.
authors.affiliation: Department of Radiation Oncology, Philadelphia, PA, USA. quon@xrt.upenn.edu.|Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, PA, USA. quon@xrt.upenn.edu.|Abramson Cancer Center, Philadelphia, PA, USA. quon@xrt.upenn.edu.|University of Pennsylvania, Philadelphia, PA, USA. quon@xrt.upenn.edu.|Hospital of the University of Pennsylvania, 3400 Spruce Street-2 Donner, Philadelphia, PA, 19104, USA. quon@xrt.upenn.edu.
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, PA, USA.|Abramson Cancer Center, Philadelphia, PA, USA.|University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia, PA, USA.|Abramson Cancer Center, Philadelphia, PA, USA.|University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
keywords: Concurrent chemotherapy; Oropharynx carcinoma; Radiotherapy; Review; Risk stratification; Transoral robotic surgery; Treatment paradigm; Treatment-related swallowing complications