Accurately identifying neck tumors using robotics improves treatment, survival, Pitt study finds

Using robotic surgery done through the mouth to more accurately identify the cause of lumps in the neck can help physicians to better target more personalized therapies for patients and dramatically improve survival, according to a study led by the University of Pittsburgh's Umamaheswar Duvvuri, M.D., Ph.D., and encompassing the largest series of patients treated with transoral robotic surgery (TORS) in the U.S.

Dr. Duvvuri, a head and neck and endocrine oncologic surgeon at UPMC and assistant professor of otolaryngology at the University of Pittsburgh School of Medicine, presented the findings at the American Society for Radiation Oncology's 55th Annual Meeting in Atlanta.

The number of head and neck cancers, especially those associated with the human papillomavirus, are on the rise. In order to best treat these cancers, doctors need a better mechanism to localize the primary tumor that metastasizes to the neck. Traditionally, these tumors were identified using endoscopy or various scans, but only 30 percent of such cases are accurately found, Dr. Duvvuri said.

"Using TORS, we can remove tissue from the back of a patient's throat and tongue to get a much more accurate result," Dr. Duvvuri said. "Doing so triples the chance of identifying the patient's tumor and improves survival compared to more traditional identification methods."

In the study, researchers examined 206 head and neck robotic cases performed at UPMC between December 2009 and December 2012. TORS was performed on 22 patients where there was a lump in the neck with unknown origin, also known as occult primary squamous cell carcinoma. Of these 22 patients, the primary tumor was identified in 19 cases.

To determine the impact of identifying the unknown primary tumor on overall survival, researchers matched 69 patients with unidentifed carcinoma (following clinical exam, imaging and surgical evaluation) and 67 patients in which the primary tumor was discovered at the initial surgical evaluation. They found a difference of more than one year in overall survival between undiscovered (8.83 years) and discovered (10.19 years).

Accurately identifying the primary tumor then allows otolaryngologists, radiation oncologists, medical oncologists and others to work together in a multidisciplinary effort on treatment, said Dwight D. Heron, M.D., professor of radiation oncology, otolaryngology and head and neck surgery at Pitt's School of Medicine, and director of radiation services, UPMC CancerCenter, partner with the University of Pittsburgh Cancer Institute.

"This really allows us to have a more holistic, team approach to cancer care and leads to more personalized treatments for our patients," Dr. Heron said.

Dr. Duvvuri and his colleagues are working to follow this review of cases with a prospective clinical trial to further understand how TORS can affect treatment and outcomes.