Paul Dent, PhD
Chief of Head and Neck Service
Andrew S. Poklepovic, MD
Vice Chair, Department
of Radiation Oncology,
The incidence of mouth and throat cancer is on the rise due to transmission of the human papilloma virus (HPV), but physicians at Memorial Sloan Kettering (MSK) Cancer Center have managed to significantly reduce the intensity of treatment and improve quality of life for these patients.
This massive decrease is due to a number of factors, but has occurred primarily because MSK employs a multidisciplinary approach to treatment planning as well as careful upfront patient selection for robotic surgery or nonsurgical treatment.
The Changing Demographic of Oropharyngeal Cancer: Including HPV as a Parameter
Historically, head and neck squamous cell cancer has been described as a homogenous disease of multiple anatomic sites that is strongly associated with tobacco and alcohol use.3
But the increase in the HPV infection rate means that this virus is now the major cause of squamous cell carcinomas of the oropharynx, responsible for more than 80% of cases. This increase has been seen predominantly in developed countries, particularly in younger men, and is associated with sexual behaviors that increase HPV exposure.4
In 2014, MSK’s Head and Neck Service began convening surgery, radiation oncology, and medical oncology specialists for a weekly disease management team (DMT) review of every patient case involving a diagnosis of squamous cell carcinoma of the oropharynx. Pathology and radiology results are assessed prior to case review by a multidisciplinary tumor board, and an individualized treatment plan is designed for each patient by team consensus.
Robotic Surgery: Patient Selection Is Key
Robotic surgery now allows for tumors from the back of the throat to be surgically removed in a minimally invasive fashion with optimal visualization through the open-mouth transoral robotic surgery (TORS) system. At MSK, a formal radiology review is performed to identify factors that lead to postoperative chemoradiation, including extra capsular spread and being at high risk for positive margins. Only specifically selected patients who meet these criteria are offered TORS.1
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