In recent years, robotic surgery for throat cancer has become more common. A study has investigated if robotic surgery was safer than radiation therapy.
Radiation therapy is typically used in the treatment of throat cancer. However, this procedure can cause several side effects, including problems swallowing. In recent years, throat cancer has begun to be treated with remotely-controlled robotic surgical tools. These robotic surgery instruments can perform the surgery from inside the mouth. Some small, early studies suggested that robotic surgery for throat cancer causes fewer side effects and swallowing problems than radiation therapy. Because of this, robotic surgery has become more common.
However, there have been no large, well-designed clinical trials to compare the effect of these two procedures on swallowing. Seven years ago, a group of Canadian and Australian surgeons designed a study to answer this question. They have just reported their results at the American Society of Clinical Oncology’s Annual Meeting.
A clinical trial to compare radiation therapy to robotic surgery for throat cancer
The researchers recruited 68 patients with throat cancer for the trial. The patients were, on average, 59 years old. The majority (87%) of them were male. They were randomly divided into two groups. The first group was treated with radiation therapy, and the second group was treated with robotic surgery. Patients in both groups also received chemotherapy if it was medically necessary.
The researchers kept track of the patients for several years after the treatment, noting any side effects and deaths. One year after treatment, they gave all patients a questionnaire on their swallowing ability.
Radiation therapy caused fewer swallowing problems than robotic surgery
Both treatments were equally effective at treating throat cancer. They resulted in the same survival rates and the same probabilities of cancer re-occurrence.
However, robotic surgery seemed to cause more swallowing problems than radiation therapy. Robotic surgery caused minor swallowing problems in 40% of patients, compared to 26% of patients treated with radiation therapy. In addition, a few of the surgery patients needed specially prepared food after the treatment.
Surgery can potentially cause serious bleeding, and, indeed, one patient died of bleeding caused by the surgical procedure. Furthermore, a year after the procedure, almost a quarter of patients who had had surgery still experienced pain. Almost half of them used painkillers. In comparison, less than 10% of the patients in the radiation group reported experiencing pain. Patients in the surgery group were also slightly more likely to report problems with their teeth.
On the other hand, radiation therapy caused its own unique side effects. Radiation-treated patients were more likely to have had short-term constipation and decreased blood cell counts. The combination of radiation therapy and chemotherapy also caused hearing problems in some patients.
Robotic surgery is not superior to radiation therapy for throat cancer
Both types of treatments were equally effective at treating the cancer, but they caused different side effects. Robotic surgery for throat cancer was more likely to lead to swallowing problems than radiation treatment. However, the differences in swallowing were relatively small. Even so, this was not what the researchers had expected. They speculated that recent improvements in radiation therapy meant that it had become safer than when robotic surgery was first introduced.
Written by Bryan Hughes, PhD
References:
Nichols, A. C., Theurer, J., Prisman, E., Read, N. E., Berthelet, E., Tran, E., Kevin, F., Almeida, J. R. d., Hope, A., Goldstein, D. P., Hier, M., Sultanem, K., Yoo, J., Macneil, S. D., Winquist, E., Hammond, A., Venkatesan, V., Kuruvilla, S., Eapen, L. & Palma, D. A. A phase II randomized trial for early-stage squamous cell carcinoma of the oropharynx: Radiotherapy versus trans-oral robotic surgery (ORATOR). Journal of Clinical Oncology 37, 6006 (2019).
Robotic surgery or radiation therapy? Clinical trial sheds light on quality of life following treatment for throat cancer. Lawson Health Research Institute. Accessed 2019-06-10 at https://www.lawsonresearch.ca/news/robotic-surgery-or-radiation-therapy-clinical-trial-sheds-light-quality-life-following
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