A recent assessment of the first 170 throat-cancer patients treated with transoral robotic surgery followed by risk-adapted adjuvant therapy at Providence Cancer Institute offers compelling evidence in favor of this new treatment approach.
Traditionally, oropharynx cancers have been treated with seven weeks of high-dose radiation plus high-dose chemotherapy. However, since HPV-related oropharynx cancers generally have a better prognosis than HPV-negative oropharynx cancers (84 percent versus 57 percent three-year survival), some scientists have argued for less-aggressive treatment regimens to improve quality of life for patients with HPV-related cancers (read more). One less-aggressive approach is transoral robotic surgery, a minimally invasive technique for removing tumors through the mouth, without incisions. The experience of the Providence Head and Neck Cancer Program appears to support this approach.
“We’ve found that treating patients first with surgery, using the da Vinci robotic surgery system, has allowed us to tailor each patient’s subsequent therapy based on the biologic behavior or aggressiveness of their disease,” says medical director R. Bryan Bell, M.D., DDS, FACS. The recent assessment of the first 170 patients found that this approach made it possible to:
- Eliminate chemotherapy in about 40 percent of patients
- Eliminate radiation therapy in about 20 percent of patients
- Substantially deescalated radiation therapy in nearly all patients who required it
Nearly all of the 170 patients followed had HPV-related cancers. Local and regional control in the group was 99 percent, and overall survival was greater than 90 percent. Other studies have shown significant improvement in overall quality of life, swallowing, taste and dry mouth, as well as much lower rates of feeding-tube dependence compared to patients who receive high-dose chemoradiation.
The transoral robotic surgery program continues to evolve and expand at Providence Cancer Institute.
In a new clinical trial, robotic surgery is now being combined with immunotherapy and condensed radiation therapy to treat patients newly diagnosed with head and neck cancers. Read more about this study.