DeCure for Oropharynx cancer

A retrospective analysis of a national cancer database identified 1603 patients with clinical stage III/IVA oropharyngeal cancer treated between 2004 and 2009, of whom 31.4% received surgery as primary treatment. After controlling for confounders, primary surgery was associated with higher survival rates, and the authors recommended surgery be considered first-line for advanced disease. A separate retrospective study of 82 patients with T2-T3 oropharyngeal cancer and N2 neck disease compared primary concurrent radiochemotherapy with salvage neck dissection (n=45) against primary transoral surgery with neck dissection and adjuvant radiochemotherapy (n=37). Regional failure occurred in 11 patients (13.4%) overall, with no significant differences between groups for regional failure (p=0.75), distant metastasis (p=0.35), or overall survival (p=0.22). However, 5-year disease-free survival was significantly worse for the radiochemotherapy group (39.0% vs 57.0%), and regional failure was more frequent in that group on univariate analysis (p=0.04). The authors concluded that treatment concept does not appear to affect regional tumour control after successful treatment of the primary tumour.

A descriptive retrospective study from a Nigerian teaching hospital analysed 62 oropharyngeal surgical biopsies collected between January 2000 and December 2010, finding 22 (35.5%) malignant lesions. Males comprised 72.7% of malignant cases, the age range was 30 to 49 years with highest frequency in the 50 to 59 year bracket, and squamous cell carcinoma was the most common histologic type (63.6%), followed by non-Hodgkin lymphomas (22.7%) and adenoid cystic carcinoma (1.6%). The authors noted that well-differentiated squamous cell carcinoma is said to have a good prognosis and called for early detection and avoidance of risk factors. A 2016 article reported on chemoradiation treatment and surgery for residual tumours after chemoradiation, taking tumour margin into account to permit adequate resection with good oncological results, though no quantitative outcomes were provided.

A 2014 chapter and a 1994 review both describe management principles for oral cavity and oropharyngeal cancer, covering anatomical aspects, staging, ablative and reconstructive surgery, radiotherapy, and chemotherapy, with the older review emphasising anatomic inaccessibility, field cancerisation, and the need to minimise speech and swallowing dysfunction. A 2018 review summarises the current evidence base and lists research questions needing urgent attention, along with ongoing clinical trials, but provides no new data. A 2019 case report describes complex prosthetic rehabilitation of a patient with an oropharyngeal malignant tumour during antitumour treatment, noting difficulties with breathing, swallowing, and speech, and the lack of a single methodological approach to treatment.

What remains missing is prospective randomised evidence comparing surgical and nonsurgical approaches with adequate sample sizes and long-term functional outcomes, particularly for swallowing and speech. The retrospective data are limited by selection bias, and the single-institution Nigerian series is small and descriptive. No trial has yet stratified patients by HPV status, which is now known to alter prognosis substantially, and the 2017 study did not report HPV data. Funding is needed for multicentre trials that randomise patients to surgery versus radiochemotherapy, with standardised neck dissection protocols and quality-of-life endpoints, before any firm recommendation can replace the current multidisciplinary default.