(459) Staged Transoral Resection of Primaries in Synchronous HPV-mediated Oropharynx Cancer

Introduction: Synchronous human papilloma virus related oropharyngeal squamous cell carcinoma (HPV+ OPSCCa) are currently treated with chemoradiation, which leads to unacceptable toxicity for patients. We propose a staged surgical excision with reduced dose adjuvant therapy as an alternative which can provide appropriate oncologic outcomes and improved functional outcomes.

Methods: A retrospective review of three cases of synchronous HPV+ OPSCCa treated by the primary author and colleagues was performed. Demographic information, surgical approach, and post-operative oncologic/functional outcomes were tabulated with Microsoft Excel.

Results: Patients presented with synchronous tumors as follows: patient 1, T2 left base of tongue and T3 right tonsil; patient 2, T1 left base of tongue and T1 right glossotonsillar sulcus, patient 3, T2 left glosso-tonsillar sulcus and T2 right lateral pharyngeal wall. Patient 3 was a heavy smoker, but the other two patients smoked less than 10 pack years. All patients underwent sequential transoral resection with selective neck dissections. Timing of surgical interval ranged from 7 days to 6 weeks. Oropharynx reconstruction was performed via radial forearm free flap for the right tonsil defect of patient 1 and right digastric flap with alloderm placement for patient 3, all other 4 defects healed via secondary intention. All patients required adjuvant radiation therapy, while patient 3 also required chemotherapy secondary to extranodal extension on final pathology. At 18 mo to 32 mo follow up, no patients displayed recurrence and were swallowing well, although Patient 3 experienced occasional VPI to liquids.

Conclusions: Staged transoral resection of synchronous HPV+ OPSCCa shows excellent oncologic outcomes at 2-3 year follow up. Use of de-escalated doses of radiation in the adjuvant setting may contribute to the acceptable swallowing outcomes that were observed in our cases.