Researchers in the Division of Head and Neck Cancer and Reconstructive Surgery have a strong interest in throat cancer (oropharyngeal squamous cell carcinoma) related to human papillomavirus (HPV). In particular, research is focused on decreasing radiation therapy after transoral robotic surgery to cure the cancer with faster treatment and better swallowing outcomes.
In partnership with Mayo Clinic's Department of Radiation Oncology and divisions of Medical Oncology and Speech Pathology, researchers in the division completed a large single-arm phase II clinical trial decreasing the standard postoperative course of radiation therapy from six weeks to two weeks.
The team found that the shorter regimen controlled the cancer as well as the traditional course, with lower toxicity and little effect on patients' ability to swallow or their quality of life. Next steps include a larger prospective, randomized control clinical trial comparing the two-week treatment with the six-week standard of care.
- Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Foster NR, Ginos B, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Olsen KD, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller R, Shiraishi S, Foote RL. Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiotherapy in human papillomavirus-associated oropharynx squamous cell carcinoma. Journal of Clinical Oncology. 2019; doi:10.1200/JCO.19.00463.
The division is using data from these trials and the results of oropharynx biomarker research to study new individualized treatment approaches, with the goal of curing HPV-related throat cancer with as few side effects as possible. An additional research goal is to offer patients a simplified and accurate follow-up schedule.
Oropharynx biomarker study
The Division of Head and Neck Cancer and Reconstructive Surgery is interested in whether a drop of blood or saliva could detect cancer better than the best imaging, or give information about the most effective treatment and follow-up.
To this end, the division is recruiting patients with HPV-related throat cancer into a prospective clinical trial investigating the prognostic significance of biomarkers in the saliva, blood and tissue. The research goal is to help clinicians tailor treatment decisions to the individual patient, improve surveillance, and potentially offer affordable and effective screening tools.
Additionally, researchers in the division work with basic scientists in the Department of Head and Neck Surgery and across Mayo Clinic to better understand the genetics, immunology and epidemiology associated with HPV-related throat cancer. Specifically, they are investigating how the tumor microenvironment, methylation patterns and circulating tumor DNA can better predict which patients will have a recurrence of the cancer and which will not.
This research will allow clinicians to adjust treatment and follow-up recommendations, identify targets for improving cure rates, and simplify follow-up.
Learning from patient experiences: Transoral robotic surgery (TORS)
With one of the largest TORS practices in the world, the Mayo Clinic Department of Head and Neck Surgery maintains an ever-growing database of patient outcomes. This vital resource allows researchers to answer meaningful retrospective questions that would be impossible to answer with prospective studies, thereby informing patient care, prospective trials and basic science.
The department has multiple ongoing studies investigating the full breadth and depth of TORS' utility in treating HPV-related throat cancer. With studies encompassing intraoperative techniques to access the upper aerodigestive tract with TORS, long-term functional and oncologic outcomes of various management approaches, and more, researchers are focused on improving patient outcomes.
Working with industry partners, the Division of Head and Neck Cancer and Reconstructive Surgery participated in the U.S. Food and Drug Administration (FDA) approval process for the da Vinci single-port robotic platform. The team was then able to complete one of the first post-approval studies investigating outcomes associated with this device.
- Holsinger FC, Magnuson JS, Weinstein GS, Chan JYK, Starmer HM, Tsang RKY, Wong EWY, Rassekh CH, Bedi N, Hong SSY, Orosco R, O'Malley Jr BW, Moore EJ. A next-generation single-port robotic surgical system for transoral robotic surgery: Results from prospective nonrandomized clinical trials. JAMA Otolaryngology — Head and Neck Surgery. 2019; doi:10.1001/jamaoto.2019.2654.
- Moore EJ, Van Abel KM, Price DL, Lohse CM, Olsen KD, Jackson RS, Martin EJ. Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes. Head & Neck. 2018; doi:10.1002/hed.25055.
- Sims JR, Van Abel K, Martin EJ, Lohse CM, Price DL, Olsen KD, Moore EJ. Management of recurrent and metastatic HPV-positive oropharyngeal squamous cell carcinoma after transoral robotic surgery. Otolaryngology — Head and Neck Surgery. 2017; doi:10.1177/0194599817696304.
- Van Abel KM, Quick MH, Graner DE, Lohse CM, Price DL, Price KAR, Ma DJ, Moore EJ. Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond. American Journal of Otolaryngology. 2019; doi:10.1016/j.amjoto.2019.07.003.
- Van Abel KM, Yin LX, Price DL, Janus JR, Kasperbauer JL, Moore EJ. One-year outcomes for da Vinci single port robot for transoral robotic surgery. Head & Neck. 2020; doi:10.1002/hed.26143.