Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): A prospective trial

- HPV negative oropharyngeal SCC has poorer response rates to treatment.
- TORS for early stage HPV negative OPSCC is feasible and oncologically safe.
- Treatment with TORS gives comparable result to CTRT with better functional outcome.

ObjectiveThis prospective study aimed to see long-term oncological outcome of Transoral Robotic Surgery as single modality treatment for cT1-T2 N0 HPV negative oropharyngeal malignancies.MethodFrom March 2013 to October 2015, 57 patients with early stage oropharyngeal carcinoma underwent Transoral robotic surgery (TORS) with neck dissection using daVinci® Surgical system. Patients were evaluated for disease free survival, overall survival, locoregional and distant metastasis.Results57 patients (48 males and 9 females) underwent TORS for early stage oropharyngeal carcinoma. All patients underwent ipsilateral neck dissection and 12 patients underwent bilateral neck dissection. 49 patients with final histopathology suggestive of stage I and II disease did not received any adjuvant treatment. Mean age at presentation was 59.4 years (37-88 years). Most common site of involvement was the base of tongue (BOT) in 31 (54.8%) patients. Twenty-four (42.1%) patients were cT1 and 33 (57.9%) were cT2 at presentation. During follow-up, 2 (4.2%) patients recurred locoreginally and 1 (2.1%) patient had distant metastasis. Two patients expired due to causes other than malignancy. Forty-three (89.6%) patients were disease free on an average follow-up of 29 months with an overall survival of 93.8% at mean follow-up of 29 months.ConclusionTransoral Robotic Surgery as a single modality treatment is a good option for cure in HPV negative early resectable oropharyngeal malignancies which are relatively unresponsive to radiation. TORS can be used to de-intensify the treatment of early stage oropharyngeal carcinoma and thus avoid the early and late toxicities associated with Radiotherapy/Chemoradiotherapy.