Comparison of survival outcomes of transoral surgery with or without adjuvant chemoradiotherapy vs chemoradiotherapy alone for oropharyngeal cancer: A systematic review and meta-analysis.

Abstract

e18109 Background: Oropharyngeal cancer is a type of head and neck cancer that starts in the tissues of the oropharynx. Optimal treatment strategies for oropharyngeal cancer remain debated, particularly the role of transoral surgery (TOS) with or without adjuvant chemoradiotherapy compared to definitive chemoradiotherapy (CRT) alone. This study aimed to compare survival outcomes, including overall survival (OS) and disease-free survival (DFS) between these approaches. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Eligible studies were identified through databases (PubMed/MEDLINE, Web of Science, Scopus and Google Scholar) published until December 2024. Studies reporting survival outcomes in oropharyngeal cancer patients treated with transoral surgery (TOS) and/or chemoradiotherapy were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS). A random-effects model was used for meta-analysis and a narrative synthesis when this was not possible. Heterogeneity was assessed using the I² statistic. For risk of bias the Newcastle-Ottawa Scale (NOS) was used. Certainty of evidence was graded using GRADE criteria. This systematic review initially aimed to evaluate the therapeutic efficacy of transoral laser microsurgery (TLM) with or without adjuvant radiotherapy vs radiotherapy alone for oropharyngeal cancer. However, the final analysis focused on transoral surgery and chemoradiotherapy as these emerged as the most consistent and clinically significant results reported across included studies. Results: Six studies (n = 587 patients) comparing transoral surgery (TOS) with or without adjuvant chemoradiotherapy (CRT) vs definitive chemoradiotherapy (CRT alone) for oropharyngeal cancer were included. All patients had Oropharyngeal squamous cell carcinoma (OPSCC). Patients treated with TOS + CRT showed longer 5-year overall survival (OS) 95% CI: (75% - 80% vs 62% - 65%) and disease-free survival (DFS) 95% CI: (70% vs 50%), with lower grade 3-4 toxicity 95% CI: (20% vs 40%, p < 0.05). Survival benefits were more pronounced in early-stage tumors (T1-T2), whereas no significant differences were observed in advanced stages. Heterogeneity was high in OS and DFS (I² = 80%). All studies had a moderate risk of bias based on the NOS scale. The certainty of the evidence was rated as low. Conclusions: Patients treated with transoral surgery (TOS) and adjuvant chemoradiotherapy (CRT) demonstrated superior overall and disease-free survival, along with reduced treatment-related toxicity, compared to definitive chemoradiotherapy (CRT alone), particularly in early-stage disease. However, due to the low certainty of the evidence and the limited number of studies, further research is recommended to confirm these results.