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Head and Neck Surgery

Survival Outcomes in HPV+ Primaries Undergoing TORS and Neck Dissection

Monday, October 2, 2023
8:18 AM - 8:24 AM East Coast USA Time
Location: 201AB

    Senior Author(s)

  • UD

    Umamaheswar Duvvuri, MD, PhD

    Professor of Otolaryngology
    Department of Otolaryngology - Head and Neck Surgery, NYU Grossman School of Medicine
    New York, New York, United States

    • Presenting Author(s)

  • Manasa K. Melachuri, MD

    PGY-1 Resident
    Southern Illinois University
    Pittsburgh, Pennsylvania, United States

  • Chareeni E. Kurukulasuriya, BS

    Medical Student
    University of Pittsburgh School of Medicine
    Pittsburgh, PA, United States

    • Co-Author(s)

  • SS

    Shaum S. Sridharan, MD

    Assistant Professor, Department of Otolaryngology and Plastic & Reconstructive Surgery
    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

  • SK

    Seungwon Kim, MD

    Associate Professor - Advanced Oncologic Head and Neck Surgery
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

  • RF

    Robert L. Ferris, MD, PhD

    UPMC Endowed Professor and Vice Chair
    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine
    Pittsburgh, Pennsylvania, USA

Disclosure(s):
Manasa K. Melachuri, MD: No relevant relationships to disclose.
Chareeni E. Kurukulasuriya, BS: No relevant relationships to disclose.
Introduction: There is limited data with little long-term follow up to evaluate whether human papilloma virus (HPV) positive primaries undergoing transoral robotic surgery (TORS) and neck dissection (ND) result in similar survival outcomes depending on time from TORS to radiation initiation (TS-R1) and time from radiation initiation to completion (TR1-R2).

Methods: Single center retrospective chart review of all patients diagnosed with HPV positive primary head and neck cancer who underwent TORS with ND from 2012-2022. Of 369 cases, 322 met inclusion criteria and were analyzed with Kaplan-Meier survival analysis with Log-rank testing to identify the impact of TS-R1 and TR1-R2 on overall survival (OS) and disease specific survival (DSS).

Results: Median follow-up time was 47.0 months (1442.86 days). Although 29 patients died when the analysis was completed, only 11 died due to recurrence. 9/16 patients had locoregional recurrence (LR) & distant metastasis (DM) while 7 had only DM. 10/16 patients had two or more episodes of recurrence while 6 had one documented recurrence.

Patients were stratified by TS-R1 from the TORS procedure. Of the 233 patients who underwent RT, 58 patients (24.87%) initiated RT within six weeks from TORS, 120 patients (51.50%) between six to nine weeks, and 55 patients (23.61%) greater than nine weeks. OS was not statistically significant (p-value=.711) between the three groups. However, OS was found to be significantly longer in patients who underwent RT for five to seven weeks compared with those who had a shortened or prolonged course of RT (p-value: .011). Overall survival for TS-R1 5-7 weeks was 106.673 months (95% CI: 102.51, 110.836) contrasted with 83.805 months (95% CI: 71.976, 95.635) and 87.325 months (76.182, 98.468) for patients with TR1-R2 < 5 and >7 weeks, respectively.

Conclusions: For HPV positive patients with OPSCC undergoing TORS and Neck dissection, time to radiation initiation may not be as critical in improving OS and DSS as other patient populations. However, the length of radiation time between five to seven weeks may significantly improving overall and disease specific survival.