Costantino Andrea, Sampieri Claudio, Sim Nam Suk, De Virgilio Armando, Kim Se-Heon
Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, 410 Celebration Place, Celebration, Orlando, Florida, 34747, U.S.A.
Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain.
Laryngoscope. 2025 Apr;135(4):1401-1408. doi: 10.1002/lary.31940. Epub 2024 Dec 5.
Transoral robotic surgery (TORS) has shown promising results in treating human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), and there has been increasing interest in incorporating neoadjuvant chemotherapy (NCT) prior to TORS. This study aimed to assess the feasibility and safety of sparing adjuvant RT following NCT and TORS.
A retrospective cohort study included consecutive patients with HPV-positive OPSCC who underwent NCT followed by TORS without adjuvant RT. Disease-free survival (DFS) was the primary outcome. Pattern of recurrence (local, regional, and distant), salvage treatment outcomes, and predictors of tumor recurrence were also assessed.
A total of 84 patients were included in the analysis. No patients died during the study period. DFS rates (95% Confidence Interval, CI) at 1, 2, and 3 years were 92.8% (87.4-98.5), 87.0% (79.7-94.9), and 84.4% (76.0-93.8), respectively. Local, regional, and distant recurrence rates were 7.0%, 9.5%, and 3.6%, respectively. Salvage treatment achieved a 100% salvage rate. Predictors of tumor recurrence included the number of positive lymph nodes (hazard ratio: 2.66; 95% CI: 1.19-5.92) and clinical stage III at diagnosis (hazard ratio: 7.65; 95% CI: 1.97-29.7).
Recommendation of adjuvant treatment based on pathologic adverse features appears to be associated with favorable outcomes in selected HPV-positive OPSCC cases treated with NCT and TORS. Future studies should focus on refining criteria for recommending adjuvant RT to further reduce recurrence rates and minimize treatment-related toxicity, contributing to personalized treatment strategies for HPV-related OPSCC.
4 Laryngoscope, 135:1401-1408, 2025.
经口机器人手术（TORS）在治疗人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）方面已显示出有前景的结果，并且在TORS之前加入新辅助化疗（NCT）的兴趣日益增加。本研究旨在评估NCT和TORS后保留辅助放疗的可行性和安全性。
一项回顾性队列研究纳入了连续的HPV阳性OPSCC患者，这些患者接受了NCT，随后接受了TORS且未进行辅助放疗。无病生存期（DFS）是主要结局。还评估了复发模式（局部、区域和远处）、挽救治疗结果以及肿瘤复发的预测因素。
共有84例患者纳入分析。研究期间无患者死亡。1年、2年和3年的DFS率（95%置信区间，CI）分别为92.8%（87.4 - 98.5）、87.0%（79.7 - 94.9）和84.4%（76.0 - 93.8）。局部、区域和远处复发率分别为7.0%、9.5%和3.6%。挽救治疗的挽救率达到100%。肿瘤复发的预测因素包括阳性淋巴结数量（风险比：2.66；95%CI：1.19 - 5.92）和诊断时临床分期为III期（风险比：7.65；95%CI：1.97 - 29.7）。
在接受NCT和TORS治疗的部分HPV阳性OPSCC病例中，基于病理不良特征推荐辅助治疗似乎与良好结局相关。未来的研究应专注于完善推荐辅助放疗的标准，以进一步降低复发率并最小化治疗相关毒性，为HPV相关OPSCC的个性化治疗策略做出贡献。
4《喉镜》，135:1401 - 1408，2025年
