Western professors David Palma and Anthony Nichols are preparing to compare robotic surgery to radiation for the treatment of oropharyngeal cancer (cancer of the back of the throat) in a first-of-its-kind study toward identifying the best treatment for patients.
Currently in Canada, radiation therapy, often combined with chemotherapy, is the accepted standard of care for patients with throat cancer. While radiation therapy provides good disease control and advances such as Intensity Modulated Radiotherapy help reduce side effects, some patients still experience long-term side effects that can be difficult to manage. Patients often complain of dry mouth, difficulty swallowing, hearing loss, skin discolouration, and taste changes.
Transoral robotic surgery (TORS) is a new method for treating throat cancer and overcomes some of the side effects and complications associated with previous surgical techniques for this cancer. Many centres in the United States are promoting its use; however, to date, no head-to-head comparison of TORS and radiation therapy has been conducted to determine which treatment truly provides the best outcomes for patients.
According to Nichols, a head and neck cancer surgeon at London Health Sciences Centre, TORS can be an ideal treatment for select patients, while sparing them from radiation-related side effects.
“Early studies of TORS show it holds promise to provide good disease control, as well as offer good speech and swallowing outcomes for patients,” said Nichols, a Lawson Health Research Institute scientist and head and neck cancer surgeon at London Health Sciences Centre (LHSC). “However, it is important that we conduct a thorough comparison of the two treatments.
As the only centre in Canada with a TORS program, located at the Canadian Surgical Technologies and Advanced Robotics at LHSC, the researchers are in a unique position to carry out a carefully controlled comparison of the two treatments.
Cases of throat cancer have more than doubled since the mid-1990s. Historically, throat cancer was mostly seen in elderly patients with a history of heavy smoking and drinking. However, physicians have seen a dramatic rise in throat cancer caused by human papilloma virus (HPV).
“Today, most of the cases we see are HPV-related,” said Palma, a radiation oncologist at LHSC. With this development has also come a change in patient demographic. “Patients who have HPV-related throat cancer are younger and usually healthier. In addition, cure rates of HPV-related cancers are better. These cancers respond well to treatment, making quality of life after treatment very important.”
Patients with early-stage oropharyngeal cancer will be randomly assigned to receive standard care (radiation therapy) or TORS. To identify which treatment is better, the researchers will gather information on quality of life, side effects, and survival.
In addition, sophisticated lab experiments and comprehensive tumour profiling (sequencing the DNA of the tumours) will be performed to help identify which patients will benefit the most from either treatment option.
“This study could lead to enhanced quality of life for Canadians living with and beyond cancer,” said Dr. Palma. “Radiation has worked very well for the treatment of these cancers and has set a very high standard for treatment. Before we can implement TORS, we need to prove that it meets that standard – are the cure rates just as good, and are the side effects less?”
“In the U.S., TORS is being used readily in the treatment of oropharyngeal cancer, in spite of the lack of high-level evidence supporting its use,” added Nichols. “This study represents a first step toward defining best practice in oropharyngeal cancer treatment in North America and worldwide.”
