11/13/2023 0 Comments Middle pharyngeal constrictor muscleFollow-up surveillance was initially performed 3 months after the operation and every 3–6 months after the initial follow-up using CT or MR imaging and/or PET/CT to assess locoregional recurrence. Adjuvant treatment was considered when the cancer-free margin was insufficient. with 10 and 15 years’ experience in head and neck surgery, respectively). 21 All included subjects underwent TORS using the da Vinci surgical robotic system (Intuitive Surgical) performed by 2 head and neck surgeons (W-J.J. The clinical primary tumor (cT) and nodal (cN) categories were staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual. Among them, 6 who received neoadjuvant therapy and 1 who did not have a postoperative pathologic report available were excluded from the analysis.Ĭlinical records were examined for demographic characteristics and staging, and treatment data were obtained from electronic medical records. Between December 2012 and May 2019 at our institution, a nationwide third-referral hospital, we included 36 subjects who met the following criteria: 1) diagnosed with HPV-positive tonsillar SCC, 2) had preoperative 3T MR imaging available, and 3) had postoperative pathologic reports available. This retrospective study was approved by our institutional review board (B-1906-544-101), and the requirement for written informed consent was waived. In our study, we aimed to identify preoperative MR imaging characteristics, particularly with regard to pharyngeal constrictor muscle involvement by the tumor in early stage cancers, that predispose the outcome of TORS toward an insecure surgical margin in HPV-positive tonsillar SCC. It has been noted that tumor invasion through the pharyngeal constrictor muscle confirmed in a surgical field will likely have a positive margin related to locoregional recurrence, but data supporting an imaging-based predictor are still lacking. However, no published study has evaluated the preoperative MR imaging characteristics that can predict the surgical margin after TORS. 3, 19 Because oncologic outcomes in such cases are similar to those with chemoradiation alone, 3 it is important to preselect patients who are expected to have an insecure surgical margin to avoid unnecessary dual treatment. 2, 3, 5, 16 ⇓- 18ĭespite these advantages, there is still a risk of obtaining an insecure surgical margin (ie, positive margin involvement by the tumor or a close margin of <1 mm between the tumor and the margin) in TORS, which necessitates adjuvant therapies, even in early T1 and T2 tumors. 14, 15 While avoiding functional deficits from the traditional external approaches, TORS can reduce the need for adjuvant therapy after surgery or can use surgery as a single-technique therapy while preserving oncologic outcomes, particularly when the negative margin is achieved by TORS. 10 ⇓ ⇓– 13 Recently, transoral robotic surgery (TORS) has emerged as a first-line treatment, particularly for early-stage HPV-positive oropharyngeal SCC. 7 ⇓- 9 Long-term adverse effects from radiation or chemotherapy and high morbidity from traditional surgery through external mandibulotomy can reduce the quality of life, particularly in young patients who have to live with the consequences for far longer. The treatment protocol for HPV-positive SCC has shifted toward a “deintensification” approach to maintain favorable oncologic outcomes while minimizing treatment-related morbidity. 3 ⇓- 5 Surgery, radiation, and chemotherapy are the main treatment methods for oropharyngeal SCC and can be used alone or in combination depending on the cancer stage. 1, 2 HPV-positive oropharyngeal SCC is known for its excellent prognosis with substantially improved survival compared with HPV-negative SCC. Oropharyngeal squamous cell carcinoma (SCC) is a head and neck cancer with increasing prevalence as a consequence of rising human papillomavirus (HPV) infections. ABBREVIATIONS: AUC area under the curve cN clinical node cT clinical tumor HPV human papillomavirus pN pathologic node pT pathologic tumor ROC receiver operating characteristic SCC squamous cell carcinoma TORS transoral robotic surgery
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |