Robotic surgery for throat cancer is not superior to radiotherapy, reveals a study

In 2012, scientists from the Lawson Health Research Institute launched the first clinical trial in the world comparing robotic surgery to radiation therapy for the treatment of oropharyngeal cancer (cancer of the throat). The team is now publishing the results of the seven-year study that challenges the view that surgery leads to better results for swallowing, suggesting that radiation improves the quality of life of patients.

For Betty Ostrander, an operating room nurse from Tillsonburg, Ontario, a diagnosis of throat cancer has changed lives. Betty was 59 when she discovered a small mbad on the right side of her neck. After seeking medical attention and undergoing tests, she was told that she had oropharyngeal cancer.

"I remember thinking," I'm healthy, I'm eating well and I'm exercising; it can not happen to me. "But it was scary," recalls Betty. "One of the first questions I asked was whether there were any clinical trials available."

Betty was one of 68 participants looking into the ORATOR trial. The study included six centers across Canada and Australia, including the London Regional Cancer Program of the London Health Sciences Center (LHSC). Participants were randomized to receive either precision radiotherapy, often badociated with chemotherapy, or transoral robotic surgery (TORS).

TORS is a surgical method for treating throat cancer using a small 3D camera and miniature robotic instruments to remove tumors. LHSC was the first center in Canada to offer TORS in 2011.

"Early studies suggested that TORS could reduce the risk of swallowing problems historically badociated with radiation and that its popularity has increased rapidly," says Anthony Nichols, a Lawson Associate Scientist and head and neck cancer surgeon at LHSC. "But there was no randomized trial comparing patient swallowing results.The first center in Canada to offer TORS, we decided to tackle this problem through testing. ORATOR. "

The research team found no difference in survival between the two groups but, surprisingly, the participants in the radiation group had better results in terms of swallowing. A slight decrease in swallowing function was observed in 40% of the participants in the surgery, compared with 26% of the participants undergoing irradiation. All participants were able to eat thoroughly after treatment, but 16% of surgical group members reported needing to prepare their food.

"Our findings challenge the notion that TORS leads to better swallowing outcomes," said David Palma, Lawson Associate Scientist and LHC's Radiation Oncologist. "While radiation has previously been badociated with poor swallowing results, treatments have progressed significantly and are now much more accurate, which can lead to better outcomes for patients."

Patients in the surgery group also had a risk of bleeding during surgery. One year after treatment, patients in the operated group were more likely to experience pain (22% vs. 8% in the radiation group), used painkillers (45% vs. 15%), had dental problems (12% ). percent versus one percent), and suffer from shoulder disorders.

The team found that patients in the radiation group had more short-term constipation and a temporary decrease in blood counts. They also presented an increased risk of tinnitus (ringing in the ears) and high hearing loss during chemotherapy, some requiring hearing aids.

"Each treatment has different potential side effects, but our results suggest that TORS is not superior to modern radiation," says Dr. Nichols. "We hope this research can be used by patients and their oncologists to inform treatment decisions."

Cases of oropharyngeal cancer have more than doubled since the 1990s. Throat cancer was more common in elderly patients with a history of smoking or excessive alcohol consumption, but doctors have There has been a dramatic increase in the number of cases caused by the human papillomavirus (HPV).

Fortunately, there is a high survival rate in patients with HPV-related throat cancer, which has led researchers to study the quality of life after treatment.

Drs. Nichols and Palma recently launched the ORATOR 2 trial, which will further compare TORS against radiotherapy and chemotherapy. The goal is to reduce the intensity of radiotherapy and chemotherapy to improve the quality of life while maintaining survival rates. The team aims to recruit 140 participants.

The results of the ORATOR trial were shared by Dr. Nichols at the annual meeting of the American Society of Clinical Oncology on May 31, 2019. The study was funded by the Society Canadian Cancer Society.

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