A seven-year, London-based study is casting doubt on the belief that robotic surgery, rather than radiation, results in better quality of life benefits for throat cancer patients.
Researchers at Lawson Health Research Institute compared the two treatments in patients with oropharyngeal cancer, a cancer in the back of the throat. Nearly 70 patients participated in the so-called ORATOR trial that began in 2012 at six centres across Canada and Australia, including the London Health Sciences Centre’s (LHSC) London Regional Cancer Program. Participants were randomly selected to receive either precision radiation therapy or transoral robotic surgery (TORS).
“Early studies suggested TORS might reduce the risk of swallowing problems historically associated with radiation and it, therefore, rose quickly in popularity,” said Dr. Anthony Nichols, associate Lawson scientist and LHSC head and neck cancer surgeon. “But there was no randomized trial to compare patients’ swallowing outcomes. As the first centre in Canada to offer TORS, we decided to tackle this problem through the ORATOR trial.”
TORS uses a small 3D camera and miniature robotic instrument to remove tumours. It was first performed in Canada at LHSC in 2011.
While researchers found no difference in survival outcomes between the two study groups, they did find participants who received radiation experienced better swallowing outcomes. In the radiation group, 26 per cent saw a mild decline in swallowing functions, compared to 40 per cent of those who received the surgery.
Researchers also found participants in the surgery group were at risk of dangerous bleeding during the procedure and were more likely to experience pain, shoulder impairment, and have issues with their teeth one year after treatment.
Patients who received radiation had more short-term constipation and a temporary drop in blood counts. They also experienced an increased risk of tinnitus and high-frequency hearing loss when receiving chemotherapy associated with the treatment.
“Each therapy has its different potential side effects but our findings suggest that TORS is not superior to modern radiation,” said Nichols. “We hope this research can be used by patients and their oncologists to help inform treatment decisions.”
Oropharyngeal cancer cases have more than doubled since the 1990s, according to Lawson. Elderly patients with a history of heavy smoking and drinking were more likely to be diagnosed with throat cancer. However, there has been a dramatic rise in the number of cases caused by human papilloma virus (HPV).
Results of the study were shared during the American Society of Clinical Oncology’s Annual Meeting last week.
Nichols, along with research partner and Radiation Oncologist at LHSC Dr. David Palma, are now working to recruit 140 more participants for a second trial to further compare the two treatments.
