Surgical Techniques, Approaches, and Results
Neck Dissection
Base of Tongue
Tonsil Cancers
Soft Palate Cancers
Minimally Invasive Transoral Surgical Approaches
Transoral Laser Mcirosurgery
Transoral Robotic Surgery
2 prospective randomized trial comparing RT to TORS
ORATOR
ORATOR2
Adjuvant Therapy Following Definitive Surgical Resection
Adjuvant CRT to OPHx Cancer
Concurrent Chemo Regimens for Adjuvant CRT
Adjuvant RT dose
57.6 Gy in 1.8 Gy to the tumor bed + boost to 63 Gy to areaes at high risk (ie, nodal regions with ENE)
Based on the available data, following are considered most appropriate.
- 60-66 Gy in 2 Gy daily fractions to high-risk areas
- 50-54 Gy in 1.8 to 2 Gy daily fractions to low-risk areas
PORT treatment volume
Definitive Radiation Therapy
RTOG 7303 (Kramer, Head Neck Surg, 1987)
Advanced SCC of OPC or OC → randomly assigned to → preop RT (50Gy), PORT (60Gy), definitive RT(65-70Gy)
Oral cavity / OPC → ethically justifiable
- 4y OS 30% vs 36% vs 33%
- 4y LRC 43% vs 52% vs 38%
PPW – De Felice et al, Head Neck, 2016
- RT±CT (n=91) vs Sg (n=89) of the PPWSCC, MFU 40mo
- 5y OS 24.1% vs 43% / 5y LRC 52.9% vs 83.2%
KROG : CRT vs Sg+PORT (Song, BMC Cancer, 2017)
. 201 had CRT, while 386 had SRT.
| 5y OS | 5y DFS | 5y LRRFS | 5y DMFS | |
| CRT | 82 | 78 | 89 | 94 |
| SRT | 81 | 73 | 87 | 89 |
→ CRT resulted in comparable oncologic outcome, despite