Author: Beatrice Fantoni, The Windsor Star

In the first trial of its kind in the world, doctors in London, Ont., are comparing robotic surgery and radiation therapy to find out which method helps throat-cancer patients retain speech and swallowing functions – two very important functions that can have a serious effect on quality of life for cancer survivors.

Dr. Anthony Nichols and Dr. David Palma of the London Health Sciences Centre are working with 68 test subjects who have cancer of the back of the throat (also known as oropharyngeal cancer) and measuring the swallowing functions of each patient one year after treatment.

Because the cure rate for oropharyngeal cancer is pretty good, Nichols said, he and Palma want to focus on how to improve patients’ post-treatment quality of life.

In Canada, the standard way of treating oropharyngeal cancer is with a combination of radiation and chemotherapy. However, Nichols said, there can be some longterm side-effects with this treatment, such as dry mouth, hearing loss, taste changes and compromised swallowing function.

“The side-effects are more than what we’d like,” said Palma. “We want to improve the quality of life.”

Surgery using a robot is a newer treatment that could perhaps be more appropriate for some oropharyngeal cancer patients, Nichols said. London is currently the only site in Canada to offer what is known as transoral robotic surgery.

The robot sounds promising, Palma said, and so it warrants more study.

“We don’t really know if the ‘surgery first’ approach is best,” Palma said, at least when it comes to swallowing.

Nichols said that cancer of the back of throat is “dramatically” on the rise in Canada partly because of the growing prevalence of the human papilloma virus.

Since the mid-1990s, the number of cases has more than doubled.

Although oropharyngeal cancer was mostly seen in older patients who were heavy smokers and drinkers, Nichols said, doctors are seeing more and more cases caused by HPV, and those cases are usually in young and otherwise healthy patients.

The trial is randomized. The patients will be randomly assigned either radiation therapy or robotic surgery.

Then, to figure out which treatment is better, Nichols and Palma will collect information about each patient’s quality of life, side-effects and survival.

Palma said they expect to have results in about five years.

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