Outcomes of primary trans-oral surgical management of early tonsillar squamous cell carcinoma with risk-adapted adjuvant radiotherapy

Background: Transoral robotic surgery (TORS) is an accepted surgical treatment modality for patients with oropharyngeal squamous cell carcinoma (OPSCC). A prospective study was conducted to test patient selection for unimodality TORS in early OPSCC, with the primary endpoint being avoidance of adjuvant radiotherapy (RT) or chemoradiation (CRT) as per recommended guidelines. Methods: Patients underwent comprehensive evaluation including multidisciplinary team (MDT) review and staging (AJCC 7th edition). Primary TORS was offered to patients with T1–2 lateralized tonsillar tumours, N0–1 with no extracapsular spread (ECS). Adjuvant RT or CRT were recommended if prespecified pathologic criteria were met, including close or positive margins, ECS and N2b disease. Results: Twenty-six patients underwent TORS, all with negative margins. Seven patients (26.9%) met one or more upstaging criteria, most commonly pN2b (5 patients, 19.2%) and close margin (3 patients, 11.5%). Five patients (19.2%) proceeded to adjuvant therapy with two patients declining further treatment. Conclusions: Single modality treatment of early tonsillar SCC utilising TORS is feasible amongst patients who undergo comprehensive evaluation including MDT review