Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial

Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation). The primary end point was swallowing quality of life (QOL) assessed with the MD Anderson Dysphagia Inventory (MDADI). Secondary end points included overall and progression-free survival (OS, PFS), adverse events (AEs), and other QOL metrics. The primary end point has been previously reported (Nichols 2019). In this report, the median follow-up was 5.1 years (IQR, 5.0-5.3 years). MDADI total scores converged by 5 years and were not significantly different across the follow-up period (<i>P</i> = .11). EORTC QLQ-C30 and H&N35 scores demonstrated differing profiles, including worse dry mouth in the RT arm (<i>P</i> = .032) and worse pain in the TORS arm (<i>P</i> = .002). Grade 2-5 AE rates did not differ between arms (91% [n = 31] <i>v</i> 97% [n = 33] respectively, <i>P</i> = .61), with more neutropenia and hearing loss in the RT arm, and more dysphagia and other pain in the TORS arm based on grades 2-5 (all <i>P</i> < .05). There were no differences in OS or PFS. In conclusion, toxicity and QOL profiles differ in some domains between RT and TORS, but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.

Authors

Institutions

Publication Details

Journal
Journal of Clinical Oncology
Published
2024-09-20
DOI
https://doi.org/10.1200/jco.24.00119
Citations
32
Primary Topic
Head and Neck Cancer Studies
Type
article
Field-Weighted Citation Impact
18.55
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial

Stephanie Johnson‐Obaseki, Sylvia Mitchell, Khalil Sultanem, S. Danielle MacNeil et al.
32 citations
Journal of Clinical Oncology
Head and Neck Cancer Studies
18.55
article

Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial

Stephanie Johnson‐Obaseki, Sylvia Mitchell, Khalil Sultanem, S. Danielle MacNeil, Hien V. Le, Jeff Chen, Eitan Prisman, Anthony C. Nichols, Michael P. Hier, Nancy Read, Eric Berthelet, Andrew Bayley, Christina Parker, Eric Winquist, John Yoo, Michael Odell, Bret Wehrli, Julie Theurer, Alex Mlynarek, Suren Krishnan, Eric Tran, John R. de Almeida, David Paul Goldstein, David A. Palma, Keith Richardson, Sara Kuruvilla, Varagur Venkatesan, Martin Corsten, Keith Kwan, J. Alex Hammond, Andrew Warner, Kevin Fung
article en
32 citations

Abstract

Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation). The primary end point was swallowing quality of life (QOL) assessed with the MD Anderson Dysphagia Inventory (MDADI). Secondary end points included overall and progression-free survival (OS, PFS), adverse events (AEs), and other QOL metrics. The primary end point has been previously reported (Nichols 2019). In this report, the median follow-up was 5.1 years (IQR, 5.0-5.3 years). MDADI total scores converged by 5 years and were not significantly different across the follow-up period (<i>P</i> = .11). EORTC QLQ-C30 and H&N35 scores demonstrated differing profiles, including worse dry mouth in the RT arm (<i>P</i> = .032) and worse pain in the TORS arm (<i>P</i> = .002). Grade 2-5 AE rates did not differ between arms (91% [n = 31] <i>v</i> 97% [n = 33] respectively, <i>P</i> = .61), with more neutropenia and hearing loss in the RT arm, and more dysphagia and other pain in the TORS arm based on grades 2-5 (all <i>P</i> < .05). There were no differences in OS or PFS. In conclusion, toxicity and QOL profiles differ in some domains between RT and TORS, but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.

Journal of Clinical OncologyVol. 42(34)
Western University (CA), Dalhousie University (CA), Royal Adelaide Hospital (AU), University Health Network (CA), University of British Columbia (CA), University of Ottawa (CA), University of Toronto (CA), London Health Sciences Centre (CA), McGill University (CA)
Good health and well-being
Openalex Percentile: Top 0%
Head and Neck Cancer Studies
18.55
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.