Modern approaches to the treatment of early HPV-associated oropharyngeal cancer
- 1Bogomolets National Medical University, Kyiv, Ukraine
- 2Nonprofit Organization National cancer institute, Kyiv, Ukraine
Summary. Objective. To analyze current scientific evidence on the efficacy of main treatment approaches for early-stage oropharyngeal cancer and to present our clinical experience with transoral CO₂ laser microsurgery as a primary treatment method in patients with T1–T2 N0–N2 M0 oropharyngeal tumors. Materials and methods. A retrospective analysis was conducted on treatment outcomes in 64 patients with squamous cell carcinoma of the oropharynx, stage T1–T2 N0–N2 M0, corresponding to early-stage disease according to the AJCC 8th edition classification. Among them, 57 patients (89.1%) had HPV-associated (p16-positive) tumors, of which 41 (64.1%) were diagnosed with stage I disease and 16 (25.0%) with stage II. The remaining 7 patients (10.9%) had HPV-negative cancer, with 4 cases (6.25%) at stage I and 3 cases (4.6%) at stage II. Results. In 59 patients (92.2%), transoral CO₂ laser resection of the oropharynx was performed using an oral retractor and/or oropharyngoscope. In 5 patients (7.8%), due to anatomical features limiting adequate visualization the base of tongue with the oropharyngoscope, surgery was carried out via an additional access-creation of a the Floor of Mouth Window for partial tongue exteriorization into the submental area, enabling en face visualization of the base of tongue for transoral CO₂ laser resection. Postoperative transient odynophagia and dysphagia occurred in 58 patients (90.6%) in the early postoperative period, typical of mucosal trauma during transoral CO₂ laser microsurgery. These functional impairments were reversible, resolving completely within 2–4 weeks due to mucosal healing and restoration of swallowing coordination. To maintain adequate nutritional status, 55 patients (85.9%) received nasogastric feeding for a mean of 5–7 days. None required prolonged tube feeding or gastrostomy. Histopathological examination of the primary tumor revealed adverse prognostic factors (lymphovascular invasion, perineural invasion, or close surgical margins) in 24 patients (37.5%), leading to adjuvant radiotherapy. In 3 patients (4.7%), high risk of recurrence (extranodal extension and/or positive resection margin (R1)) warranted adjuvant chemoradiotherapy. Overall, adjuvant treatment (radiotherapy or chemoradiotherapy) was administered in 27 patients (42.2%), while 37 patients (57.8%) were observed without additional therapy. Surgical complications were rare and clinically insignificant: 4 patients (6.25%) experienced moderate postoperative bleeding, managed conservatively with local coagulation and hemostatic agents. No patient required reoperation or transfusion support. Particular attention is given to the minimally invasive surgical approach in 5 patients (7.8%) with tumors of the tongue base, where the Floor of Mouth Window technique demonstrated high safety and efficacy without specific complications such as hypoglossal nerve neuropraxia or sublingual ranula formation. During a 12-month follow-up with regular clinical examinations, endoscopic monitoring, and CT / MRI imaging, no cases of recurrence or disease progression were recorded. These findings confirm the oncologic effectiveness of transoral CO₂ laser microsurgery, provided careful patient selection and adherence to the surgical protocol. Conclusions. The obtained results demonstrate that transoral CO₂ laser microsurgery is a highly effective and safe primary treatment for early-stage oropharyngeal cancer (T1–T2 N0–N2 M0), provided appropriate patient selection and strict compliance with surgical standards. Further comparative studies are needed to evaluate transoral CO₂ laser microsurgery versus radiotherapy as primary treatment modalities for early-stage oropharyngeal cancer, including assessment of oncologic outcomes, functional results, and quality of life.
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