title: Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery.
abstract: Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery-based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days-6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery-based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Sims
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Van Abel
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Eliot J
authors.initials: EJ
authors.lastname: Martin
authors.affiliation: 2 Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Price
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kerry D
authors.initials: KD
authors.lastname: Olsen
authors.affiliation: 1 Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome
keywords: TORS; distant metastasis; oropharyngeal; oropharynx; recurrence; salvage; squamous cell carcinoma; transoral robotic surgery