Lörincz Balazs B, Möckelmann Nikolaus, Busch Chia-Jung, Münscher Adrian, Sehner Susanne, Dalchow Carsten V, Knecht Rainald
Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1028-33. doi: 10.1245/s10434-015-4581-5. Epub 2015 May 13.
To date, this prospective cohort study is the largest of its kind from a single European academic tertiary care center to report 2-year survival outcomes for head and neck squamous cell carcinoma treated primarily with transoral robotic-assisted resection.
Fifty consecutive, appropriately staged patients were enrolled prospectively, and underwent transoral robotic surgery (TORS) between September 2011 and August 2013. Overall, 24 patients had a T1 primary tumor, 23 had a T2 primary tumor, 2 had a T3 primary tumor, and 1 had a T4a primary tumor. Eighteen patients had overall stage I-II disease, and 32 patients had stage III-IV disease. Following transoral robotic resection of their primaries and appropriate neck dissection(s) as indicated, adjuvant treatment could be spared for 20 patients; another 5 patients refused the recommended adjuvant treatment. Seventeen patients received 60 Gy adjuvant radiotherapy and 8 patients underwent 66 Gy adjuvant chemoradiotherapy.
At the time of the last follow-up visit (median 27 months), overall survival was 94 %, with two disease-specific deaths and one unrelated death (heart attack). The 2-year disease-free and recurrence-free survival rates were 88 and 80 %, respectively; however, the local recurrence rate was only 10 % after 2 years.
Using TORS as their primary modality, 40 % of patients did not need adjuvant treatment and showed similar survival rates to that of conventional surgery or primary chemoradiotherapy. In another 34 % of patients, adjuvant chemotherapy could be spared and adjuvant radiotherapy could be reduced by 10 Gy compared with primary chemoradiotherapy of 70 Gy. Further studies are warranted with respect to long-term survival.
迄今为止，这项前瞻性队列研究是来自单一欧洲学术三级医疗中心同类研究中规模最大的，报告了主要采用经口机器人辅助切除术治疗的头颈部鳞状细胞癌的2年生存结果。
前瞻性纳入50例分期合适的连续患者，于2011年9月至2013年8月接受经口机器人手术（TORS）。总体而言，24例患者为T1期原发肿瘤，23例为T2期原发肿瘤，2例为T3期原发肿瘤，1例为T4a期原发肿瘤。18例患者为整体I-II期疾病，32例患者为III-IV期疾病。在经口机器人切除原发肿瘤并根据需要进行适当的颈部清扫后，20例患者无需辅助治疗；另外5例患者拒绝推荐的辅助治疗。17例患者接受60 Gy辅助放疗，8例患者接受66 Gy辅助放化疗。
在最后一次随访时（中位时间27个月），总生存率为94%，有2例疾病特异性死亡和1例非相关死亡（心脏病发作）。2年无病生存率和无复发生存率分别为88%和80%；然而，2年后局部复发率仅为10%。
以TORS作为主要治疗方式，40%的患者无需辅助治疗，其生存率与传统手术或原发放化疗相似。另外34%的患者可避免辅助化疗，与70 Gy的原发放化疗相比，辅助放疗剂量可减少10 Gy。关于长期生存，有必要进行进一步研究。
