Neoadjuvant chemotherapy followed by transoral robotic surgery versus upfront surgery for locoregionally advanced oropharyngeal carcinoma: A propensity score matched analysis

Background Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced‐stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate. Methods A retrospective bi‐centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups. Results Among the 300 patients with stage III‐IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16‐positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort ( p < 0.001) due to the lower frequency of pathological risk factors after NAC. Conclusions NAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non‐inferior survival outcomes to upfront surgery, while in the p16‐positive population allowed to significantly spare adjuvant therapy.