A Systematic Review of Transoral Robotic Surgery and Radiotherapy for Early Oropharynx Cancer: A Systematic Review
A Systematic Review of Transoral Robotic Surgery and Radiotherapy for Early Oropharynx Cancer: A Systematic Review
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DOI：
10.1002/lary.24712
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发表时间：
2014-09-01
期刊：
影响因子：
2.6
通讯作者：
Genden, Eric M.
中科院分区：
文献类型：
--
作者：
de Almeida, John R.;Byrd, James K.;Genden, Eric M.
目的/假设：比较经口机器人手术(TORS)和调强放射治疗(IMRT)治疗早期T期口咽癌的疗效。资料来源：检索MEDLINE、EMBASE、CENTARY、ENTHINO、CINAHL和2012年9月之前相关研究的参考文献。研究检索和数据提取一式两份，以协商一致方式解决。收集了治疗的具体细节，以及复发、存活率和不良事件。结果：纳入20个病例系列，包括8个调强放射治疗研究(1287名患者)和12个Tors研究(772名患者)。接受明确的调强放疗的患者还接受了化疗(43%)或颈部清扫术(30%)，而接受TORS的患者需要辅助放射治疗(26%)或放化疗(41%)。调强放疗的两年总生存率估计在84%到96%之间，而Tors的估计在82%到94%之间。调强放射治疗的不良反应包括食道狭窄(4.8%)、放射性骨坏死(2.6%)和胃造瘘管(43%)，而Tors的不良反应包括手术时(1.4%)或辅助治疗期间(30%)出血(2.4%)、瘘(2.5%)和胃造瘘管(30%)。12%的患者在手术时需要气管切开导管，但大多数在出院前拔管。结论：这篇综述表明，两种方法的生存估计是相似的，差异在于不良事件。
Objectives/Hypothesis: To demonstrate the comparative effectiveness of transoral robotic surgery (TORS) to intensity modulated radiotherapy (IMRT) for early T-stage oropharyngeal cancer.Data Sources: The search included MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, and bibliographies of relevant studies through September 2012.Methods: Studies included patients treated for early T-stage oropharynx cancer with TORS or IMRT. Study retrieval and data extraction were conducted in duplicate and resolved by consensus. Treatment-specific details, as well as recurrence, survival, and adverse events, were collected. Methodologic quality for each study was appraised.Results: Twenty case series, including eight IMRT studies (1,287 patients) and 12 TORS studies (772 patients), were included. Patients receiving definitive IMRT also received chemotherapy (43%) or neck dissections for persistent disease (30%), whereas patients receiving TORS required adjuvant radiotherapy (26%) or chemoradiotherapy (41%). Two-year overall survival estimates ranged from 84% to 96% for IMRT and from 82% to 94% for TORS. Adverse events for IMRT included esophageal stenosis (4.8%), osteoradionecrosis (2.6%), and gastrostomy tubes (43%)-and adverse events for TORS included hemorrhage (2.4%), fistula (2.5%), and gastrostomy tubes at the time of surgery (1.4%) or during adjuvant treatment (30%). Tracheostomy tubes were needed in 12% of patients at the time of surgery, but most were decannulated prior to discharge.Conclusion: This review suggests that survival estimates are similar between the two modalities and that the differences lie in adverse events.