Surgery- vs Radiation-Based Therapy for p16+/HPV-Related Oropharyngeal Cancers

Abstract

Purpose of Review

Oropharyngeal cancer (OPC) has traditionally been managed by radiotherapy (RT)-based approaches. Minimally invasive surgery [transoral robotic surgery (TORS)/transoral laser microsurgery (TLMS)] is gaining popularity in T1-T2 HPV+ OPC. However, there is lack of high level evidence to guide practice. We summarize ongoing research regarding outcomes and investigational strategies for TORS/TLM- and RT-based treatments for this disease.

Recent Findings

Literature published in 2012–2017 demonstrated comparable exemplary outcomes with TORS/TLM and IMRT for selected HPV+ T1-T2 OPC. However, many TORS/TLM-treated patients also require adjuvant treatment, which impacts quality of life. Emerging RT-based de-intensification trial data suggest promising results. Ongoing investigation include indications for postoperative (chemo-)radiotherapy following TORS/TLM- and optimal RT-based de-intensification strategies.

Summary

A contemporary literature review demonstrates equal efficacy for TORS/TLM and IMRT as primary treatment for selected HPV+ T1-T2 OPC. TORS/TLM is an attractive approach when the opportunity for single modality treatment is high.

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