Who Are The Candidates For Tors?
The best patients for TORS generally include early tumors (smaller than 4 cm in size) of the oropharynx (base of tongue and tonsil) and laryngopharynx (supraglottis and pharyngeal wall). These patients do very well with TORS, many of the getting cure just with this surgery alone. Some may need further treatment like radiation with or without chemotherapy, however, the dose that would be required will be much lower and tolerable.Some selected patients with tumours larger than 4 cm may also benefit from TORS. However, these patients are selected carefully.
The patients who have had recurrence of cancer following chemoradiation or for tumors left behind after completion of chemoradiation had no hope before TORS came into picture. Today these patients do well with the help of this new technology.
If statistically significant risk to the neck for spread of tumor exists, or if clinically evident neck nodal disease is present, neck dissection is usually performed during or 1 to 3 weeks after the TORS procedure. This surgery can be performed by minimally invasive technique called MIND.
Following TORS and neck dissection, about 70% of patients can be spared chemotherapy and approximately 30% can avoid radiation treatment based on histologic findings. The radiation dose that is required also is much lower than the conventional. This avoids many of the long-term complications associated with conventional chemo-radiotherapy.