Oncologic outcomes and patient-reported quality of life in patients with oropharyngeal squamous cell carcinoma treated with definitive transoral robotic surgery versus definitive chemoradiation

Abstract

Objective It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic and quality of life (QOL) outcomes between definitive CRT and definitive TORS. Materials and methods An observational comparison study was performed on 92 patients treated with TORS ± adjuvant therapy and 46 patients treated with definitive CRT between July 2005 and January 2016. The Kaplan Meier method was used for survival analyses, and the Mann-Whitney test was used to compare QOL scores between groups. Results All patients had T0-T2 and N0-N2 disease, although CRT patients had higher clinical staging (p < 0.001). HPV+ disease was present in 79% (n = 73) of TORS patients and 91% (n = 19) of tested CRT patients. Median follow-up was 22.1 months (range: 0.33–83.4). There were no significant differences in locoregional control or overall survival between CRT and TORS groups. Definitive TORS resulted in better saliva-related QOL than definitive CRT at 1, 6, 12, and 24 months (p < 0.001, p = 0.025, p = 0.017, p = 0.011). Among TORS patients, adjuvant therapy was associated with worse QOL in the saliva domain at 6, 12, and 24 months (p < 0.001, p < 0.001, p = 0.007), and taste domain at 6 and 12 months (p = 0.067, p = 0.008). Conclusion Definitive CRT and definitive TORS offer similar rates of locoregional control, overall survival, and disease-free survival in patients with early stage OPSCC. TORS resulted in significantly better short and long-term saliva-related QOL, whereas adjuvant therapy was associated with worse saliva and taste-related QOL compared to TORS alone.