Oropharyngeal cancer: A case for single modality treatment with transoral laser microsurgery

Objective: To demonstrate the role of transoral laser microsurgery( TLM) in the treatment of oropharyngeal cancer. Design: A 2-center retrospective case series analysis. Setting: Two tertiary care medical centers. Patients: The study population comprised 69 patients with previously untreated select T1 to T3, N0 to N2 squamous cell carcinoma of the oropharynx, of whom 44 (74%) had no indication for adjuvant RT and 25 (36%) had an indication for adjuvant RT to the neck alone but declined radiotherapy. The primary tumor sites were the tonsil (n=28 [41%]), tongue base (n=28 [41%]), pharyngeal wall (n=8 [12%]), soft palate (n=4 [6%]), and vallecula (n=1 [1%]). Interventions: Transoral laser microsurgery in 69 patients, with neck dissection in 59 patients (83%). Main Outcome Measures: Complications, local and regional control, overall and disease-specific survival, swallow function, and feeding tube dependence. Results: Over the mean follow-up period of 44 months, 66 of 69 patients had no disease recurrence at the primary site. The 5-year local control estimate was 94%. The mean duration of hospitalization was 3 days. There were no major complications relating to TLM. No patient required a permanent feeding or tracheostomy tube. For stage I, II, and III disease, the 5-year Kaplan-Meier estimates of locoregional control were 90%, 73%, and 70%, respectively. The 5-year overall survival estimate was 86%. Conclusions: Transoral laser microsurgery alone with or without neck dissection is an effective approach for select T1 to T3, N0, or N1 oropharyngeal cancer. Low levels of morbidity, short treatment duration, and excellent disease control make it an attractive therapeutic strategy. The treatment option of endoscopic-assisted laser microsurgery should be discussed by the multidisciplinary team for patients presenting with tumors suitable for this approach.