Tzu Chi Medical Journal
Volume 20, Issue 1 , Pages 49-57, March 2008

The Role of Primary Surgery in Resectable Stage III/IV Tonsillar Carcinoma

  • Hon-Yi Lin

      Affiliations

    • Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan
    • ,
  • Yee-Min Jen

      Affiliations

    • Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
    • ,
  • Dai-Wei Liu

      Affiliations

    • Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Jing-Min Hwang

      Affiliations

    • Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
    • ,
  • Moon-Sing Lee

      Affiliations

    • Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Shih-Kai Hung

      Affiliations

    • Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • ,
  • Hsing-Lung Chao

      Affiliations

    • Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
    • ,
  • Chun-Shu Lin

      Affiliations

    • Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
    • ,
  • Weng-Yoon Shum

      Affiliations

    • Department of Radiation Oncology, Jen-Ai Hospital, Taichung, Taiwan

Received 15 August 2007; received in revised form 29 August 2007; accepted 26 September 2007.

Article Outline

Abstract 

Objective

This study intends to define the role of primary surgery for patients with resectable stage III/IV tonsillar carcinoma.

Materials and Methods

From 1987 to 2004, 82 patients with resectable stage III/IV tonsillar carcinoma were treated curatively with surgery plus radiotherapy (n = 22), concurrent chemoradiotherapy (n = 25), or radiotherapy alone (n = 35). We compared surgery plus radiotherapy with concurrent chemoradiotherapy and radiotherapy alone. The primary endpoint was 5-year overall survival.

Results

The median follow-up time was 39 months (range, 1–216 months). All living patients were followed-up for at least 2 years. The 5-year overall survival for surgery plus radiotherapy was similar to that of concurrent chemoradiotherapy (52.9% vs. 58.9%; hazard ratio [HR], 1.46; 95% confidence interval [CI], 0.71–3.01; p = 0.31) and radiotherapy alone (52.9% vs. 45.7%; HR, 0.87; 95% CI, 0.47–1.62; p = 0.66). For 5-year local control, surgery plus radiotherapy was better than radiotherapy alone (68.1% vs. 42.8%; HR, 0.39; 95% CI, 0.16–0.98; p = 0.045). T4 disease resulted in poorer local control than T1–3 disease (HR, 5.89; 95% CI, 2.36–14.70; p < 0.0001). After multivariate analysis, treatment modality had a consistent statistically insignificant impact on all clinical outcomes of interest.

Conclusion

For patients with resectable stage III/IV tonsillar carcinoma, surgery plus radiotherapy is comparable to concurrent chemoradiotherapy and results in better local control than radiotherapy alone. Current evidence is still insufficient to definitively recommend replacing primary surgery with nonsurgical treatment modalities. [Tzu Chi Med J 2008;20(1):49–57]

Keywords:  Concurrent chemoradiotherapy (CCRT) , Organ preservation Radiotherapy (RT) , Surgery plus radiotherapy , Tonsillar carcinoma

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PII: S1016-3190(08)60008-7

doi:10.1016/S1016-3190(08)60008-7

Tzu Chi Medical Journal
Volume 20, Issue 1 , Pages 49-57, March 2008

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