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Invited Commentary
November 15, 2010

To TORS or Not to TORS: But Is That the Question?Comment on “Transoral Robotic Surgery for Advanced Oropharyngeal Carcinoma”

Author Affiliations

Author Affiliations: Departments of Radiation Oncology (Dr Garden), Thoracic/Head and Neck Medical Oncology (Dr Kies), and Head and Neck Surgery (Dr Weber), The University of Texas M. D. Anderson Cancer Center, Houston.

Arch Otolaryngol Head Neck Surg. 2010;136(11):1085-1087. doi:10.1001/archoto.2010.184

National Cancer Center Network guidelines1 for the treatment of locally advanced squamous cell cancer of the oropharynx are broad. Related to precise site and tumor staging, recommendations vary from chemoradiotherapy, to surgery with or without adjuvant therapy based on the surgical pathologic findings, to induction chemotherapy followed by locoregional therapy. Randomized trials have been performed, but most often the focus has been on the potential role of systemic therapy tested either as a radiation-sensitizing concomitant strategy with the objective of improving locoregional disease control or as a component of a sequential treatment program with higher chemotherapy dose levels. Surgery and radiotherapy are powerful local treatments, but which patients should undergo surgery remains a conundrum. Parsons et al2 compiled a review of work published during a 30-year period to evaluate the results of therapy for oropharyngeal cancer and concluded that radiotherapy (with or without neck dissection) and surgery (with or without adjuvant radiotherapy) resulted in similar disease control and survival rates but a greater complication rate in patients treated with surgery. The authors concluded that radiotherapy is preferable for most patients with oropharyngeal cancer. This conclusion and randomized trials demonstrating improved disease control and survival rates with concomitant chemoradiotherapy have led to an increased use of chemoradiotherapy for locally advanced oropharyngeal cancer. Moreover, although improvements in survival rates have been made for patients with oropharyngeal cancer treated with chemoradiotherapy over radiotherapy as a single modality, these improvements have come at increased treatment complexity, cost, and overall toxic effects.