Can concurrent chemoradiotherapy replace surgery and postoperative radiation for locally advanced stage III/IV tonsillar squamous cell carcinoma?

Geumju Park, Sang Wook Lee, Sang Yoon Kim, Soon Yuhl Nam, Seung Ho Choi, Sung Bae Kim, Jong Lyel Roh, Dok Hyun Yoon, Su Ssan Kim, Jin Hong Park, Young Seok Kim, Sang Min Yoon, Si Yeol Song, Jong Hoon Kim, Eun Kyung Choi, Seung Do Ahn

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations

Abstract

Aim: To compare surgery and postoperative radiotherapy (PORT) with the non-surgical combination of chemotherapy and radiation therapy (CCRT) for locally advanced squamous cell carcinoma (SCC) of the tonsil by measuring treatment outcomes and treatment-related complications. Patients and Methods: The records of 114 patients with non-metastatic stage III/IV tonsillar SCC treated between July, 1998 and December, 2010 were reviewed retrospectively. Among the 114 patients, 65 received PORT and 49 received CCRT. In the PORT group, treatment included wide surgical resection of the tumor with neck dissection and administration of PORT to the primary tumor bed with a median dose of 60 Gy. In the CCRT group, a median dose of 70 Gy was delivered to the gross tumor, and 46 patients received concurrent chemotherapy with i.v. cisplatin. The median follow-up time was 58 months in the PORT group and 44 months in the CCRT group. Results: There was no significant difference between PORT and CCRT in terms of 5-year locoregional recurrence-free survival (88.4% vs. 91.4%, p=0.68), distant metastasis-free survival (88.9% vs. 92.3%, p=0.60), disease-free survival (79.5% vs. 84.2%, p=0.63) or overall survival (78.9% vs. 88.9%, p=0.45). More CCRT patients than PORT patients experienced grade 3 (or higher) hematological toxicities and grade 2 pharyngitis during treatment. Chronic toxicity, manifested as swallowing difficulty, dry mouth and trismus, was similar between the two treatment groups. Conclusion: CCRT provides similar levels of local and distant control in patients with locally advanced tonsillar SCC as PORT, yet fails to show any superiority in preserving functions such as swallowing, saliva production, and mastication.

Original languageEnglish (US)
Pages (from-to)1237-1244
Number of pages8
JournalAnticancer Research
Volume33
Issue number3
StatePublished - Mar 2013

Keywords

  • Concurrent chemoradiotherapy
  • Radiotherapy
  • Surgery
  • Tonsil cancer

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