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DonB Offline OP
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Last week there was a seminar on Head & Neck Cancer presented by the UCSD CCC's H&N department at a public library in one of our nearby beach communities. The room was packed.

As part of their surgical presentation they briefly touched on their current TORS program (after a detailed, but gory, graphic jaw replacement and ND slide-show).

The seminar ran out of time and the Library had to close, so there wasn't much of a Q&A session. So, I wondering about the adoption and use of TORS elsewhere.


Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

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TransOral Robotic Surgery (TORS) was invented and developed by the pioneering team of Gregory S. Weinstein, MD and Bert W. O'Malley, Jr., MD at the Hospital of the University of Pennsylvania (HUP). Weinstein is my husband's surgeon. TORS is obviously used at Penn. Who were the presenters at the seminar? Were they from Penn?


Anita (68)
CG to husband, Clark, 79,
DX SCC 11/07, T4N0Mx, PEG 1/08, RAD, post rad infection 3/08,
HBOT 40 dives, ORN, Surg 11/09 mandibulectomy w/fibular graft.
Plastic Surg 4/10, 12/10, 3/11, 10/11, 4/12, 10/12. All PETS clear,
PEG out 1/11. 6/11 non union jaw fracture
Fractured jaw w/surgery 7/14
Aspiration pneumonia 7/21, 10/22
PEG 7/21
Botox injections
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DonB Offline OP
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@Anita
The surgical presentation was by UCSD (Moores NCI designated CCC) doctors/prof Kevin Brumund and Robert Weisman. They were way behind schedule and TORS was the last segment, so it was barely touched on, but interesting.

I'm hoping our local H&N Support Group can invite them. Dr. Brumund has attended in the past.

U-Penn didn't get mentioned, probably due to time.

Did Clark have TORS?



Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

Joined: Sep 2009
Posts: 701
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Clark did not have TORS as FDA approval happened after his initial cancer surgery. Here is the news release from December 2009:

http://www.uphs.upenn.edu/news/News_Releases/2009/12/tors-robotic-head-neck-surgery/

Anita


Anita (68)
CG to husband, Clark, 79,
DX SCC 11/07, T4N0Mx, PEG 1/08, RAD, post rad infection 3/08,
HBOT 40 dives, ORN, Surg 11/09 mandibulectomy w/fibular graft.
Plastic Surg 4/10, 12/10, 3/11, 10/11, 4/12, 10/12. All PETS clear,
PEG out 1/11. 6/11 non union jaw fracture
Fractured jaw w/surgery 7/14
Aspiration pneumonia 7/21, 10/22
PEG 7/21
Botox injections
Joined: Mar 2008
Posts: 3,082
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Anita

Thanks for that link. I had asked my ENT about doing TORS for my surgery back in January 2009 but she said it was still waiting for FDA approval and my recurrence could not wait a year to attack since the tumor might spread to my larynx and lungs.
I never got around to seeing when the FDA finally approved it, so her guess was pretty good with December 18 of 2009 being just about a year.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
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Don

You are so good at keeping up on the improvements for TX. If you do get a chance to question some surgeons on TOR, would you mind asking how long it takes a surgeon to get competent with this variant of the DaVinci system?
Our own Doc Brooks story about his surgeon doing the new laser surgery for the first time and the horrific results is a cautionary tale about how experience does really matter in surgery with these new technologies.
When I had to have root canals after my first radiation TX, my prosthodontist sent me to a specialist who did them while looking thru a high powered microscope the entire time. He said it took him three years to get really good with it.
TORS sounds really promising but it was not quite ready for prime time when I needed it. I've been reading glowing newspaper reports all the time on it by patients in my google reader.
Charm


65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Jul 2008
Posts: 507
DonB Offline OP
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Charm
I'll ask one of our local Support Group coordinators to invite Dr. Brumund to discuss TORS, but I understand it might be difficult to get him right away.

He also teaches OC lip reconstruction at other campuses and seems to spend considerable time at UCSF.

His lip work is quite amazing, but I think he would tell you everything he does is (reminds me in a way of you smile ).

I've seen UC slide presentations of laser oral tongue surgery and it reminded me of Dr. Brook's experience. I think they are supposed to practice on cadavers, not fellow docs.


Don
TXN2bM0 Stage IVa SCC-Occult Primary
FNA 6/6/08-SCC in node<2cm
PET/CT 6/19/08-SCC in 2nd node<1cm
HiRes CT 6/21/08
Exploratory,Tonsillectomy(benign),Right SND 6/23/08
PEG 7/3/08-11/6/08
35 TomoTherapy 7/16/08-9/04/08 No Chemo
Clear PET/CT 11/15/08, 5/15/09, 5/28/10, 7/8/11

Joined: Mar 2008
Posts: 3,082
Patient Advocate (old timer, 2000 posts)
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Don

Thanks. Yeah, I get why he reminds you of me. Guilty as charged. My RO was infuriating because he was so much like me but he was the best one at the CCC.
Be careful of being too funny now with your posts or someone might start flaming you. For example, your remark about cadavers is undoubtedly offensive to "Mortuo-Americans"
PS. I took that term from a very old sarcastic Law School Review article on Estates and Trusts and Discrimination Law but I never had a chance to use it here on OCF - thanks
Keep the Faith
Charm

Last edited by Charm2017; 04-25-2011 02:14 PM. Reason: toned it down

65 yr Old Frack
Stage IV BOT T3N2M0 HPV 16+
2007:72GY IMRT(40) 8 ERBITUX No PEG
2008:CANCER BACK Salvage Surgery
25GY-CyberKnife(5) 3 Carboplatin
Apaghia /G button
2012: CANCER BACK -left tonsilar fossa
40GY-CyberKnife(5) 3 Carboplatin

Passed away 4-29-13
Joined: Jul 2011
Posts: 42
Contributing Member (25+ posts)
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Joined: Jul 2011
Posts: 42
I'm getting scheduled for TORS at Johns Hopkins in the next few weeks. I'll put up a separate thread about my experience after it occurs.

Right now, the doctor estimates that I will have the feeding tube out before I leave the hospital, and he expects a 1-2 night stay. I have a 1.5cm right BOT tumor.

Even if I end up needing adjuvant RT, the reduced dose will be much appreciated! They are using somewhere near 57 Gy if clear margins are obtained, as opposed to 70+ to treat primaries.


Age 35
non-smoker, non-drinker
7/1/11 - Diagnosed with SCC @ BOT, stage 1, lingual tonsil & cyst removed
8/9/11 - Corrected diagnosis of MEC @ BOT
8/17/11 - TORS to remove lesion
9/2/11 - Bilateral neck dissection. All nodes clear! Done!
12/13/11 - PET/CT scan clear
Joined: Dec 2010
Posts: 5,260
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"OCF Canuck"
Patient Advocate (old timer, 2000 posts)
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thats awesome good luck with your surgery... will say a prayer you get through it safely and with clear margins!


Cheryl : Irritation - 2004 BX: 6/2008 : Inflam. BX: 12/10, DX: 12/10 : SCC - LS tongue well dif. T2N1M0. 2/11 hemigloss + recon. : PND - 40 nodes - 39 clear. 3/11 - 5/11 IMRT 33 + cis x2, PEG 3/28/11 - 5/19/11 3 head, 2 chest scans - clear(fingers crossed) HPV-, No smoke, drink, or drugs, Vegan
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