• Providers and Locations
• Audiology
• Balance Center
• Cranial Base Surgery
• Facial Plastic and Reconstructive Surgery
• General Otolaryngology
• Head and Neck Cancer Surgery
• Rhinology (Sino-Nasal Conditions and Surgery)
• Otology/Neurotology
• Smell and Taste Disorders
• Speech-Language Pathology
• TransOral Robotic Surgery
  • Benefits
  • What to Expect
  • Before TORS
  • Staging Endoscopy for Appropriate Patient Selection
  • After TORS
  • Staged Neck Dissection after TORS
  • Postoperative Radiation after TORS
  • TORS for Sleep Apnea
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• Voice, Speech and Swallowing Disorders

For Patients Make an Appointment Encyclopedia Articles about Ear, Nose and Throat

Is Radiation Therapy After TransOral Robotic Surgery (TORS) Needed?

The decision to recommend postoperative radiation therapy is based on the final report from the pathology from both the TORS case and the neck dissection. If the pathologist finds more than one lymph node involved by the cancer, the patient will need radiation therapy. If the cancer involves the nerves which is called “perineural invasion”, radiation is recommended to decrease recurrence of the cancer.

What are the Situations when Both Chemotherapy and Radiation will be Recommended After TransOral Robotic Surgery (TORS)?

There have been two major studies of the benefits of postoperative chemoradiation, one in Europe and one in the United States. The studies focused on identifying which pathologic factors put patients at higher risk of cancer recurrence. When these studies were combined, the two most important factors were positive margins (cancer left behind after TORS) or extracapsular spread in the neck (cancer spreading outside the lymph nodes into the surrounding fat or muscle.) Since positive margins are extremely rare, the main reason for recommended chemotherapy and radiation after TORS is extracapsular spread of cancer outside the lymph nodes.

The TORS Team at Penn was the first in the world to show that following TORS the intensity of radiation can be decreased— which translates to better swallowing outcomes when compared to chemoradiation alone without TORS.

Why Undergo TORS if the Patient will Receive Chemoradiation Anyway?

One question the patient or referring physician might pose is “why undergo surgery in the first place if the patient may need chemoradiation after surgery anyway?” Following the treatment of head and neck cancer, patients can be at risk for recurrence in three places:

1. The primary site in the throat where the cancer began
2. The neck
3. Elsewhere in the body

By utilizing surgery first, the patient can minimize the risk of cancer recurrence both in the neck and the primary site, and if the patient is then noted to have high risk factors pathologically, he/she can undergo chemotherapy and radiation to minimize the risk of spread elsewhere in the body (distant metastasis). Since TORS is minimally-invasive, and the neck dissection is most often “selective”, the side effects are low. Additionally, the chemoradiation that is given after surgery is less intense than it would have been if no TORS was performed, and this is likely the reason that patients that undergo TORS have better long-term swallowing function with lower rates than patient reported in the literature that underwent chemoradiation without TORS. Finally, only about half of the patients that undergo TORS need chemotherapy as part of the postoperative regimen, and chemotherapy is a very toxic treatment that is best avoided when possible.

 

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