Ashish Patel, M.D., D.D.S., F.A.C.S., a fellowship-trained head and neck surgical oncologist and reconstructive surgeon at Providence Cancer Institute, helped develop the recommendations. He says they reflect what Providence has been doing for years. "We've always been ahead of the curve,” he said.
HPV and head and neck cancer
Over the past 30 years, the number of people diagnosed with oropharyngeal cancer has risen sharply. This type of cancer affects the tonsils, base of tongue, soft palate and surrounding throat structures. Once linked primarily to tobacco and alcohol use, the disease has shifted. Today, the majority of cases in the United States are caused by the human papillomavirus, or HPV.
"HPV infection is one of many factors that can increase someone's risk of cancer,” Dr. Patel said.
Moving beyond one-size-fits-all care
Historically, oropharyngeal squamous cell carcinoma has been treated with combinations of radical surgery, high-dose platinum-based chemotherapy and radiation. Although those approaches remain effective and continue to have utility in some cases, unfortunately, the side effects can be significant and lifelong. Patients may have trouble swallowing or experience trismus or osteoradionecrosis of the jaw—complications that cause jaw stiffness or limit the ability of the mouth to open fully. Some complications may persist long after treatment ends.
"There are a lot of ways to cure cancer which, in my opinion, are not compatible with a meaningful life," Dr. Patel said. "The question is: How do we treat and cure this cancer and give our patients a life that's better? How do we make the treatment better than the disease?"
A minimally invasive surgical option
Transoral robotic surgery, known as TORS, is a key tool in that approach. FDA-approved and in clinical use for more than 15 years, TORS allows surgeons to access and remove tumors through the mouth using robotic instruments, avoiding large incisions and the morbidity of open surgery.
For some patients, TORS can reduce and eliminate the need for radiation or chemotherapy. Providence Cancer Institute has published data showing outcomes comparable to, and in some cases, better than chemoradiation, with significantly fewer long-term side effects.
"With robotic surgery, we can often avoid chemotherapy, decrease the amount of radiation, and sometimes eliminate radiation altogether," Dr. Patel said. "It's a tailored approach.” This treatment allows the oncology team to study the resected tumor and develop individual treatment plans for each patient’s cancer.
Guidelines built for everyday practice
The new ASCO guidelines are designed to make the full body of evidence accessible to clinicians across specialties, including those who may not work routinely with a head and neck surgeon.
"We spent a year—radiation oncologists, medical oncologists, surgical oncologists, speech therapists—collating the data to boil it down to something easily digestible," Dr. Patel said.
The recommendations are comprehensive, recognizing that no two patients or cancers are alike. They are freely available through ASCO without a journal subscription and are intended for use by medical oncologists, radiation oncologists, head and neck surgeons and allied health professionals.
"I suspect it will spark a lot of discussion and help people change practice patterns or reinforce the ones they already have,” Dr. Patel said.
Leading the way in head and neck cancer treatment
TORS has contributed to advancing cancer care and research at Providence Cancer Institute. In 2011, Bryan Bell, M.D., D.D.S., FACS, FRCS(Ed), executive medical director, Providence Cancer Institute, director, Earle A. Chiles Research Institute, was one of the first surgeons in the world to use transoral robotic surgery (TORS) to treat head and neck cancer.
Currently, a clinical trial enrolling patients at Providence is exploring the use of neoadjuvant therapy followed by minimally invasive robotic surgery to assess treatment response. The study was spearheaded by Dr. Bell and Rom Leidner, M.D.; and former researcher Marka Crittenden, M.D., Ph.D.
The trial has drawn national attention. "My hope is that it will change the standard of care," Dr. Patel said. "And that wouldn't be possible without transoral robotic surgery."
Find out more
If you have questions about TORS or other types of treatments for head and neck cancer, find out more about the Head and Neck Cancer Program at Providence Cancer Institute.
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