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Article: The interplay of IMRT and transoral surgery in HPV-mediated oropharyngeal cancer: Getting the balance right

TitleThe interplay of IMRT and transoral surgery in HPV-mediated oropharyngeal cancer: Getting the balance right
Authors
KeywordsHPV
Oropharyngeal cancer
Transoral surgery
IMRT
De-intensification
Issue Date2018
PublisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/oraloncology
Citation
Oral Oncology, 2018, v. 86, p. 171-180 How to Cite?
AbstractTransoral surgery (TOS) and IMRT represent two primary local ablative treatment modalities for oropharyngeal cancer (OPC). The choice of one over the other represents an interplay between the chance of cure vs risk of late sequelae. HPV-mediated (HPV+) OPC patients generally have excellent outcomes, especially in TNM-8 stage I disease. Controversies exist over which treatment has a more favorable toxicity profile and equal efficacy in the management of this population. Non-randomized retrospective data show comparable oncological and functional outcomes between TOS-based vs IMRT-based treatment for this disease. Several de-intensification concepts have been explored in this subset in both primary surgery-based vs primary radiotherapy-based trials. However, no robust mature trial data are available to convincingly guide treatment selection. TOS is often presented as one of the de-intensification options although the majority of series also describe the use of adjuvant treatments which inevitably result in non-negligible toxicities. Patient selection and surgeons’ training are paramount. Understanding tumor biology and the prognostic value of traditional ‘adverse’ features will further guide trial design for refinement of risk tailored approach. In conclusion, comparative data suggests TOS and IMRT are both effective treatment for TNM-8 stage I HPV+ OPC with similar oncological and functional outcomes. TOS as a single modality has potential advantages in mitigating radiation included toxicities. TOS should be avoided in the presence of clinically overt extranodal extension or when negative margins are unlikely to be achieved. TOS is also less ideal for cases with radiological features predicting a high risk of distant metastasis.
Persistent Identifierhttp://hdl.handle.net/10722/273433
ISSN
2017 Impact Factor: 4.636
2015 SCImago Journal Rankings: 1.764

 

DC FieldValueLanguage
dc.contributor.authorHuang, SH-
dc.contributor.authorHahn, E-
dc.contributor.authorTsang, RK-
dc.contributor.authorChen, ZJ-
dc.contributor.authorO'Sullivan, B-
dc.date.accessioned2019-08-06T09:28:52Z-
dc.date.available2019-08-06T09:28:52Z-
dc.date.issued2018-
dc.identifier.citationOral Oncology, 2018, v. 86, p. 171-180-
dc.identifier.issn1368-8375-
dc.identifier.urihttp://hdl.handle.net/10722/273433-
dc.description.abstractTransoral surgery (TOS) and IMRT represent two primary local ablative treatment modalities for oropharyngeal cancer (OPC). The choice of one over the other represents an interplay between the chance of cure vs risk of late sequelae. HPV-mediated (HPV+) OPC patients generally have excellent outcomes, especially in TNM-8 stage I disease. Controversies exist over which treatment has a more favorable toxicity profile and equal efficacy in the management of this population. Non-randomized retrospective data show comparable oncological and functional outcomes between TOS-based vs IMRT-based treatment for this disease. Several de-intensification concepts have been explored in this subset in both primary surgery-based vs primary radiotherapy-based trials. However, no robust mature trial data are available to convincingly guide treatment selection. TOS is often presented as one of the de-intensification options although the majority of series also describe the use of adjuvant treatments which inevitably result in non-negligible toxicities. Patient selection and surgeons’ training are paramount. Understanding tumor biology and the prognostic value of traditional ‘adverse’ features will further guide trial design for refinement of risk tailored approach. In conclusion, comparative data suggests TOS and IMRT are both effective treatment for TNM-8 stage I HPV+ OPC with similar oncological and functional outcomes. TOS as a single modality has potential advantages in mitigating radiation included toxicities. TOS should be avoided in the presence of clinically overt extranodal extension or when negative margins are unlikely to be achieved. TOS is also less ideal for cases with radiological features predicting a high risk of distant metastasis.-
dc.languageeng-
dc.publisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/oraloncology-
dc.relation.ispartofOral Oncology-
dc.subjectHPV-
dc.subjectOropharyngeal cancer-
dc.subjectTransoral surgery-
dc.subjectIMRT-
dc.subjectDe-intensification-
dc.titleThe interplay of IMRT and transoral surgery in HPV-mediated oropharyngeal cancer: Getting the balance right-
dc.typeArticle-
dc.identifier.emailTsang, RK: rkytsang@hku.hk-
dc.identifier.authorityTsang, RK=rp01386-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.oraloncology.2018.09.020-
dc.identifier.pmid30409297-
dc.identifier.scopuseid_2-s2.0-85053838875-
dc.identifier.hkuros300940-
dc.identifier.volume86-
dc.identifier.spage171-
dc.identifier.epage180-
dc.publisher.placeUnited Kingdom-

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