Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, United States; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States; Surgery Service, Department of Veterans Affairs Medical Center, Seattle, WA, United States.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
Oral Oncol. 2017 Sep;72:150-156. doi: 10.1016/j.oraloncology.2017.07.019. Epub 2017 Jul 25.
Our primary objective is to describe the post- operative management in patients with an unknown primary squamous cell carcinoma of the head and neck (HNSCC) treated with trans-oral robotic surgery (TORS).
MATERIALS & METHODS: We conducted a retrospective multi-institutional case series including all patients diagnosed with an unknown primary HNSCC who underwent TORS to identify the primary site from January 1, 2010 to June 30, 2016. We excluded those with recurrent disease, ≤6months of follow up from TORS, previous history of radiation therapy (RT) to the head and neck, or evidence of primary tumor site based on previous biopsies. Our main outcome measure was receipt of post-operative therapy.
The tumor was identified in 26/35 (74.3%) subjects. Post-TORS, 2 subjects did not receive adjuvant therapy due to favorable pathology. Volume reduction of RT mucosal site coverage was achieved in 12/26 (46.1%) subjects who had lateralizing tumors, ie. those confined to the palatine tonsil or glossotonsillar sulcus. In addition, for 8/26 (30.1%), the contralateral neck RT was also avoided. In 9 subjects, no primary was identified (pT0); four of these received RT to the involved ipsilateral neck nodal basin only without pharyngeal mucosal irradiation.
Surgical management of an unknown primary with TORS can lead to deintensification of adjuvant therapy including avoidance of chemotherapy and reduction in RT doses and volume. There was no increase in short term treatment failures. Treatment after TORS can vary significantly, thus we advocate adherence to NCCN guideline therapy post-TORS to avoid treatment-associated variability.
我们的主要目标是描述经口机器人手术（TORS）治疗头颈部（HNSCC）不明原发灶的鳞状细胞癌患者的术后管理。
我们进行了一项回顾性多机构病例系列研究，纳入了所有 2010 年 1 月 1 日至 2016 年 6 月 30 日期间接受 TORS 以确定原发灶的头颈部不明原发灶 HNSCC 患者。我们排除了那些有复发性疾病、TORS 后随访时间≤6 个月、头颈部既往放疗史或基于既往活检有原发肿瘤部位证据的患者。我们的主要观察指标是接受术后治疗。
在 35 例患者中有 26 例（74.3%）肿瘤得到识别。在 TORS 后，由于病理良好，2 例患者未接受辅助治疗。26 例肿瘤侧化患者（即局限于腭扁桃体或舌扁桃体沟的患者）中有 12 例（46.1%）实现了 RT 黏膜部位覆盖的体积减少。此外，8 例（30.1%）也避免了对侧颈部 RT。在 9 例患者中，未发现原发灶（pT0）；其中 4 例仅接受受累同侧颈部淋巴结区的 RT，而不进行咽部黏膜照射。
TORS 治疗不明原发灶可减少辅助治疗的强度，包括避免化疗和减少 RT 剂量和体积。短期治疗失败率没有增加。TORS 后的治疗方法差异很大，因此我们主张遵循 NCCN 指南治疗，以避免治疗相关的变异性。
