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First ever trial comparing robotic surgery to radiation therapy will impact care for cancer patients worldwide

July 13, 2012

Lawson's Drs. David Palma and Anthony Nichols
On July 12, 2012, Lawson Health Research Institute announced the launch of the ORATOR trial.  This landmark study is the first trial in the world to compare robotic surgery to radiation for the treatment of oropharyngeal cancer (cancer of the back of the throat). 


Lawson’s Drs. David Palma and Anthony Nichols will examine the impact of both treatments on patients’ speech and swallowing function, and quality of life as a first step toward identifying the best treatment for patients.


Currently in Canada, radiation therapy, often combined with chemotherapy, is the accepted standard of care for patients with throat cancer.  While radiation therapy provides good disease control and advances such as Intensity Modulated Radiotherapy help reduce side effects, some patients still experience long-term side effects that can be difficult to manage. Patients often complain of dry mouth, difficulty swallowing, hearing loss, skin discolouration, and taste changes. 

Transoral robotic surgery (TORS) is a new method for treating throat cancer and overcomes some of the side effects and complications associated with previous surgical techniques for this cancer.  Many centres in the United States are promoting its use; however, to date, no head-to-head comparison of TORS and radiation therapy has been conducted to determine which treatment truly provides the best outcomes for patients.


According to Dr. Anthony Nichols, a head and neck cancer surgeon at London Health Sciences Centre, TORS can be an ideal treatment for select patients, while sparing them from radiation-related side effects.  “Early studies of TORS show it holds promise to provide good disease control, as well as offer good speech and swallowing outcomes for patients. However, it is important that we conduct a thorough comparison of the two treatments,” says Dr. Nichols.  As the only centre in Canada with a TORS program (located at the Canadian Surgical Technologies and Advanced Robotics (CSTAR)) the researchers are in a unique position to carry out a carefully controlled comparison of the two treatments.


Cases of throat cancer have more than doubled since the mid-1990s.  Historically, throat cancer was mostly seen in elderly patients with a history of heavy smoking and drinking. However, physicians have seen a dramatic rise in throat cancer caused by human papilloma virus (HPV). “Today, most of the cases we see are HPV-related,” says Dr. David Palma, a radiation oncologist at LHSC.  With this development has also come a change in patient demographic.  “Patients who have HPV-related throat cancer are younger and usually healthier,” says Dr. Palma. “In addition, cure rates of HPV-related cancers are better. These cancers respond well to treatment, making quality of life after treatment very important.”


Patients with early-stage oropharyngeal cancer will be randomly assigned to receive: (1) standard care (radiation therapy); or (2) TORS.  To identify which treatment is better, the researchers will gather information on quality of life, side effects, and survival.  In addition, sophisticated lab experiments and comprehensive tumour profiling (sequencing the DNA of the tumours) will be performed to help identify which patients will benefit the most from either treatment option.


“This study could lead to enhanced quality of life for Canadians living with and beyond cancer,” says Dr. Palma. “Radiation has worked very well for the treatment of these cancers and has set a very high standard for treatment.  Before we can implement TORS, we need to prove that it meets that standard – are the cure rates just as good, and are the side effects less?”


According to Dr. Nichols, “In the U.S., TORS is being used readily in the treatment of oropharyngeal cancer, in spite of the lack of high-level evidence supporting its use.  This study represents a first step toward defining best practice in oropharyngeal cancer treatment in North America and worldwide.”


Department of Oncology Chair/Chief at LHSC Dr. Glenn Bauman states, “ORATOR asks an important question regarding the relative benefits of two advanced therapeutic technologies (TORS vs. Intensity Modulated Radiotherapy) for head and neck cancer.  Through its interdisciplinary research teams and advanced treatment facilities London is uniquely positioned to conduct trials like ORATOR that will help define new standards of care for cancer patients.”