Randomized trial: [Chemo]RT > TORS for HPV+ OPSCC

[Krukenberg]

Clinical future is still bright in rad onc. ORATOR trial randomized patients to RT +\- chemo or TORS for T1-2N0-2. Swallow scores statistically superior in RT arm at 1 Year. To be presented at oral session at ASCO.

If deintensified RT works out this difference may be even greater.

A phase II randomized trial for early-stage squamous cell carcinoma of the oropharynx: Radiotherapy versus trans-oral robotic surgery (ORATOR). | 2019 ASCO Annual Meeting Abstracts

6006 A phase II randomized trial for early-stage squamous cell carcinoma of the oropharynx: Radiotherapy versus trans-oral robotic surgery (ORATOR). Anthony Charles Nichols, Julie Theurer, Eitan Prisman, Nancy E Read, Eric Berthelet, Eric Tran, Fung Kevin, John R. de Almeida, Andrew Hope, David...

abstracts.asco.org

Edit: ChemoRT if N+. Otherwise RT alone

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[medgator]

Clinical future is still bright in rad onc. ORATOR trial randomized patients to RT +\- chemo or TORS for T1-2N0-2. Swallow scores statistically superior in RT arm at 1 Year. To be presented at oral session at ASCO.

If deintensified RT works out this difference may be even greater.

A phase II randomized trial for early-stage squamous cell carcinoma of the oropharynx: Radiotherapy versus trans-oral robotic surgery (ORATOR). | 2019 ASCO Annual Meeting Abstracts

6006 A phase II randomized trial for early-stage squamous cell carcinoma of the oropharynx: Radiotherapy versus trans-oral robotic surgery (ORATOR). Anthony Charles Nichols, Julie Theurer, Eitan Prisman, Nancy E Read, Eric Berthelet, Eric Tran, Fung Kevin, John R. de Almeida, Andrew Hope, David...

abstracts.asco.org

Edit: ChemoRT if N+. Otherwise RT alone

Good luck getting aggressive ENTs to start referring to you. Some of them are just as bad as urologists, operating where they shouldn't be and calling it De-escalation

 

[deleted941485]

Good luck getting aggressive ENTs to start referring to you. Some of them are just as bad as urologists, operating where they shouldn't be and calling it De-escalation

We have ENTs who have threatened to stop referring for patients to us that they think are excellent TORS candidates. It’s clearly something not open for discussion at tumor board at some shops.

 

[scarbrtj]

Good luck getting aggressive ENTs to start referring to you. Some of them are just as bad as urologists, operating where they shouldn't be and calling it De-escalation

We have ENTs who have threatened to stop referring for patients to us that they think are excellent TORS candidates. It’s clearly something not open for discussion at tumor board at some shops.

Looks like ENTs who want to do TORS, but can't, can get pretty.... TORSed about it. Boom.

 

[evilbooyaa]

Meh, I'm seeing how this is going to play out.

Argument that the difference in MDADI scores does not meed 'clinically significant' threshold set prior to the trial.

ENTs will argue that RT induced neutropenia, tinnitus, and constipation(? not sure how they're going to explain that one on RT) is worse than TORS induced trismus.

It'll end up being like prostate cancer. Different toxicities for different treatments, but as long as surgeons see them first they're going to push for surgery. I'm interested in what percentage of patients require adjuvant RT or chemoRT after TORS. In P16+ OPhx patients should almost never get surgery, chemo, and RT IMO.

For young patients at high probability of being managed successfully with TORS alone, I think this outcome will not push those patients more to RT.

I think all patients being considered for TORS should be discussed in a multidisciplinary tumor board and/or seen in consultation by both surgery and radiation oncology at minimum. However, I say the same thing about prostate cancer and it's all institution dependent.

But it is good to see some data suggesting that RT is better than surgery in this regard. If anyone is going to ASCO and has access to the slides after the presentation I would be very interested in seeing them rather than waiting 2+ years for the paper (probably).

 

[Krukenberg]

Meh, I'm seeing how this is going to play out.

Argument that the difference in MDADI scores does not meed 'clinically significant' threshold set prior to the trial.

ENTs will argue that RT induced neutropenia, tinnitus, and constipation(? not sure how they're going to explain that one on RT) is worse than TORS induced trismus.

It'll end up being like prostate cancer. Different toxicities for different treatments, but as long as surgeons see them first they're going to push for surgery. I'm interested in what percentage of patients require adjuvant RT or chemoRT after TORS. In P16+ OPhx patients should almost never get surgery, chemo, and RT IMO.

For young patients at high probability of being managed successfully with TORS alone, I think this outcome will not push those patients more to RT.

I think all patients being considered for TORS should be discussed in a multidisciplinary tumor board and/or seen in consultation by both surgery and radiation oncology at minimum. However, I say the same thing about prostate cancer and it's all institution dependent.

But it is good to see some data suggesting that RT is better than surgery in this regard. If anyone is going to ASCO and has access to the slides after the presentation I would be very interested in seeing them rather than waiting 2+ years for the paper (probably).

Manuscript is under review

 

[Palex80]

"Best Of" is still recruiting addressing the same question. However accrual rates are pretty bad...

ClinicalTrials.gov

clinicaltrials.gov