title: Minimizing adjuvant treatment after transoral robotic surgery through surgical margin revision and exclusion of radiographic extracapsular extension: A Prospective observational cohort study.
abstract: We investigated in a prospective cohort of patients treated with trans-oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra-capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo-radiation therapy (CRT) without jeopardizing tumor control and functional outcome.
  
  
  
  We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer.
  
  
  
  Twenty-nine patients with T1/2N0 to N2B stage cancers were treated with TORS. Forty-five percent of them were treated for secondary primaries. Nine of 29 patients (31%) were revised for close/positive margins. Adjuvant RT was prescribed for 2 of 19 patients with early squamous cell carcinoma (SCCs) and CRT for 1 of 10 patients with advanced oropharyngeal SCCs. Overall survival (OS), disease-specific survival (DSS), and locoregional control at 2 years were 85%, 96%, and 93%, respectively. Posttreatment Functional Outcome Swallowing Scale (FOSS) scores worsened with prior or adjuvant RT, local recurrence, site, and revision for margins.
  
  
  
  Patients with early and moderately advanced oropharyngeal SCC selected for radiographic ECS and revised for inadequate margins have excellent tumor control and favorable functional recovery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 965-973, 2017.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Benoit
authors.initials: B
authors.lastname: Morisod
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Ioana I
authors.initials: II
authors.lastname: Venara-Vulpe
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Alzuphar
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Yan
authors.initials: Y
authors.lastname: Monnier
authors.affiliation: Institute of Pathology, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bongiovanni
authors.affiliation: Department of Radiology, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Patric
authors.initials: P
authors.lastname: Hagmann
authors.affiliation: Department of Radiation Oncology, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Hanan
authors.initials: H
authors.lastname: Bouchaab
authors.affiliation: Department of Radiation Oncology, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Simon
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D065287:Robotic Surgical Procedures; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Functional Outcome Swallowing Scale (FOSS) score; head and neck cancer; head and neck squamous cell carcinoma (HNSCC); oropharyngeal neoplasm; transoral robotic surgery (TORS)