Should Tonsillar Carcinoma With Nasopharynx Invasion Alone be Classified as a T4b Disease?

Lee, Moon-Sing; Jen, Yee-Min; Liu, Dai-Wei; Su, Yu-Chieh; Hung, Shih-Kai; Hwang, Jing-Min; Lee, Ching-Chih; Li, Szu-Chi; Tsai, Wei-Ta; Chen, Fong-Ling; Lin, Hon-Yi

doi:10.1016/S1016-3190(09)60040-9

« Previous Next »Tzu Chi Medical Journal
Volume 21, Issue 3 , Pages 204-209, September 2009

Should Tonsillar Carcinoma With Nasopharynx Invasion Alone be Classified as a T4b Disease?

Moon-Sing Lee
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
Yee-Min Jen
- Department of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
Dai-Wei Liu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Yu-Chieh Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Hematology-Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Shih-Kai Hung
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
Jing-Min Hwang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Szu-Chi Li
- Division of Hematology-Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Wei-Ta Tsai
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Fong-Ling Chen
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
Hon-Yi Lin
- Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Corresponding author. Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan

Received 11 November 2008; received in revised form 15 December 2008; accepted 19 February 2009.

Abstract

Objective

The aim of this study was to explore the role of nasopharynx (NP) invasion alone in tonsillar carcinoma.

Materials and Methods

From 1987 to 2005, 32 patients with unresect-able cT4b tonsillar carcinoma were retrospectively divided into two groups: the NP-only group, that included 11 patients with NP invasion alone without fitting other T4 criteria; and the other-T4b group, that included the remaining 21 patients. Local control and overall survival were the main endpoints of interest.

Results

At the time of this analysis, 28 patients had died, with a median follow-up time for all 32 patients of 13 months (range, 1-228 months). The mean follow-up period for the four living patients was 180 months (range, 125-228 months). When compared with the other T4b patients, patients with NP invasion alone, without fitting other T4 criteria, had greater 5-year local control (63.6% vs. 14.3%, p = 0.026; hazard ratio for local failure, 0.31; 95% confidence interval, 0.11-0.94) and 5-year overall survival (45.5% vs. 10.3%, p = 0.022; hazard ratio for death from any cause, 0.34; 95% confidence interval, 0.13-0.89).

Conclusion

In patients with tonsillar carcinoma, nasopharynx invasion alone should not be considered as an independent criterion of T4b classification in the next version of cancer staging.

Keywords: Cancer stage , Concurrent chemoradiotherapy , Nasopharynx , Radiotherapy , Tonsillar carcinoma

No full text is available. To read the body of this article, please view the PDF online.

Back to Article Outline

References

National Comprehensive Cancer Network . National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Head and Neck Cancers, Version 2, 2008 . Available from http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf [Date accessed: January 5, 2009]
- View In Article

Adelstein DJ , Li Y , Adams GL , et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer . J Clin Oncol . 2003;21:92–98

Fallai C , Bolner A , Signor M , et al. Long-term results of conventional radiotherapy versus accelerated hyperfractionated radiotherapy versus concomitant radiotherapy and chemotherapy in locoregionally advanced carcinoma of the oropharynx . Tumori . 2006;92:41–54
- View In Article
- MEDLINE

In: Greene FL , Page DL , Fleming ID , et al. editor. American Joint Committee on Cancer Staging Manual . 6^th edition. Philadelphia: Springer; 2002;p. 27–39
- View In Article

In: Greene FL , Compton CC , Fritz AG , Shan JP , Winchester DP editor. American Joint Committee on Cancer (AJCC)– Cancer Staging Atlas . 7^th edition. New York: Springer Science + Business Media; 2006;p. 27–39
- View In Article

Bensadoun RJ , Benezery K , Dassonville O , et al. French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: results at 2 years (FNCLCC-GORTEC) . Int J Radiat Oncol Biol Phys . 2006;64:983–994

Chao KS , Ozyigit G , Blanco AI , et al. Intensity-modulated radiation therapy for oropharyngeal carcinoma: impact of tumor volume . Int J Radiat Oncol Biol Phys . 2004;59:43–50

Lee WR , Mendenhall WM , Parsons JT , Million RR , Cassisi NJ , Stringer SP . Carcinoma of the tonsillar region: a multivariate analysis of 243 patients treated with radical radiotherapy . Head Neck . 1993;15:283–288

Lin HY , Jen YM , Liu DW , et al. The role of primary surgery in resectable stage III/IV tonsillar carcinoma . Tzu Chi Med J . 2008;20:49–57
- View In Article

Brizel DM , Albers ME , Fisher SR , et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer . N Engl J Med . 1998;338:1798–1804