Treatment with robotic surgery offers dramatic benefit for people with head and neck cancer

The Mount Sinai Hospital / Mount Sinai School of MedicineJul 27 2012

Predictors of disease severity in human papillomavirus-derived head and neck cancer, tobacco use, and the dramatic benefits of robotic surgery in people with head and neck cancer are among landmark research presented by Mount Sinai School of Medicine at the Eighth International Conference on Head and Neck Cancer. The meeting took place from July 21-25, 2012 in Toronto.

In a retrospective study of 35 smokers and 22 nonsmokers who were treated with transoral robotic surgery and evaluated after 19.9 months, researchers found that progression-free survival was 91 percent and 96 percent and overall survival was 97 percent and 100 percent for the smoking and nonsmoking groups, respectively. They also found 94 percent and 96 percent of tumors removed using robotic surgery did not come back in the smoking and nonsmoking groups, respectively; and that the surgery prevented metastasis in 97 percent and 100 percent of these patients.

"Historically, tobacco users have a five-year disease-free survival rate of 50-60 percent. Early results of this study suggest a significant improvement in outcomes," said senior author Eric M. Genden, MD, Director of the Head and Neck Cancer Center.

"The prognosis for smokers who are diagnosed with head and neck cancer has historically been poor," said Chaz L. Stucken, MD, Chief Resident, Otolaryngology, Mount Sinai School of Medicine. "However, our analysis shows that robotic surgery is highly effective in treating these patients and should be considered as a primary treatment modality in this patient population."

Transoral robotic surgery (TORS) shows positive survival outcomes in treating head and neck cancer, according to a presentation from John R. de Almeida, MD, who conducted the research as an Otolaryngology fellow at Mount Sinai. In this retrospective analysis, Dr. de Almeida and his team evaluated 237 patients treated with TORS. Twenty-six percent received adjunctive radiotherapy and 32 percent received adjunctive chemotherapy. Two-year disease-specific survival and overall survival were 94 percent and 98 percent, respectively, and 21 patients experienced a recurrence.

With a dramatic increase in the number of cases of head and neck cancer associated with HPV, researchers from Mount Sinai set out to determine whether the number of metastatic lymph nodes, a well-established measure of disease severity in the more typical tonsil cancer patient with a history of smoking and/or drinking, apply to HPV-positive tonsil cancer. They evaluated 1,515 patients from the pre-HPV era (1988-1997) and 5,139 patients from the HPV-predominant era (1998-2007), all from the Surveillance, Epidemiology, and End Results database. They found that while metastatic lymph nodes are still important in informing prognosis, their significance is diminished since HPV has become a predominant cause of cancer.

"Our analysis shows that in this new era of HPV-positive tonsil cancer, we need to find new ways to assess disease prognosis," said Andrew Sikora, MD, Assistant Professor, Otolaryngology and co-author on this study. "This is further evidence that HPV-positive head and neck cancer is a disease distinct from the traditional 'smoker-drinker' head and neck cancer case."