Cancer Res Treat.  2005 Apr;37(2):92-97.

Retrospective Analysis of the Treatment Results for Patients with Squamous Cell Carcinoma of Tonsil

• Chang AR
• Wu HG
• Park CI
• Kim KH
• Sung MW
• Heo DS

Abstract

PURPOSE
There has been no definitive randomized study to identify the optimal therapeutic regimen for treating squamous cell carcinoma of tonsil. The purpose of this study was to retrospectively evaluate the treatment outcome according to various combinations of surgery, radiation therapy and chemotherapy. MATERIALS AND METHODS: Fifty-six patients with tonsillar carcinoma, who were treated at Seoul National University Hospital from March 1985 to August 2001, were the subjects of this study. Twenty-one patients received surgery followed by radiation therapy (SRT), 16 patients underwent radiation therapy alone (RT), and 19 patients received neoadjuvant chemotherapy and radiation therapy (CRT). The median radiation dose was 66.6 Gy for the SRT group and 70.2 Gy for the RT and CRT groups. Surgery comprised extended tonsillectomy and modified radical neck dissection of the involved neck. Cisplatin and 5-fluorouracil were used every three weeks for 3 cycles in the SRT group. The median follow-up was 73.2 months. RESULTS: The distribution of T-stage was 4 cases of T1, 14 cases of T2, 1 case of T3 and 2 cases of T4 staging in the SRT group, 2 cases of T1, 6 cases of T2, 5 cases of T3 and 3 cases of T4 staging in the RT group and 0 cases of T1, 7 cases of T2, 9 cases of T3 and 3 cases of T4 staging in the CRT group. The distribution of N-stage was 5 cases of N0, 2 cases of N1, 13 cases of N2 and 1 case of N3 staging in the SRT group, 6 cases of N0, 5 cases of N1, 5 cases of N2 and 0 cases of N3 staging in the RT group, and 2 cases of N0, and 7 cases of N1, 9 cases of N2 and 1 case of N3 staging in the CRT group. The five-year overall survival rate (OSR) for all patients was 78%. The five-year OSR was 80% for the SRT group, 71% for the RT group, and 80% for the CRT group (p=ns). The five-year disease-free survival rate was 93% for the CRT group and 71% for the RT group (p=0.017). Four patients developed local failure and one patient failed at a regional site in the RT group, and one patient failed at a primary site in the CRT group. The five-year DFS was 84% for patients who had undergone neck dissection and 76% for patients who had not undergone neck dissection (p=ns). Treatment-related complications of grade 3 or 4 occurred in 15 patients, and the incidence of complication was not different between each of the treatment methods. CONCLUSION: Although the patients with more advanced T stage were included in the RT and CRT groups, the OSR was not statistically different according to the treatment methods. In the radical radiation therapy group, the addition of neoadjuvant chemotherapy showed an improvement in the disease-free survival. Because of the retrospective nature of our study and the small number of patients, this study cannot draw any definite conclusions, but it suggests that radiation therapy with chemotherapy can be a good alternative option for squamous cell carcinoma of tonsil. Controlled randomized study is necessary to confirm this hypothesis.

Keyword

Squamous cell carcinoma of tonsil; Radiation therapy; Surgery; Chemotherapy

MeSH Terms

Carcinoma, Squamous Cell*
Cisplatin
Disease-Free Survival
Drug Therapy
Fluorouracil
Follow-Up Studies
Humans
Incidence
Neck
Neck Dissection
Palatine Tonsil*
Retrospective Studies*
Seoul
Survival Rate
Tonsillectomy
Treatment Outcome
Cisplatin
Fluorouracil

Figure

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  Fig. 1 Overall survival accordilng to treatment modality. SRT: surgery +RT; CRT: chemotherapy +RT; RT: radiation therapy.

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  Fig. 2 Disease free survival according to treatment modality.

Reference

1. Bopp FP, White JA. Tonsil cancer. J La State Med Soc. 1989; 141:11–14. PMID: 2656893.

2. Jones AS, Fenton JE, Husband DJ. The treatment of squamous cell carcinoma of the tonsil with neck node metastases. Head Neck. 2003; 25:24–31. PMID: 12478540.

3. Parsons JT, Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Villaret DB, et al. Squamous cell carcinoma of the oropharynx: surgery, radiation therapy or both. Cancer. 2002; 94:2967–2980. PMID: 12115386.

4. Roy S, Tibesar RJ, Daly K, Pambucian S, Lee HK, Gapany M, et al. Role of planned neck dissection for advanced metastatic disease in tongue base or tonsil squamous cell carcinoma treated with radiotherapy. Head Neck. 2002; 24:474–487. PMID: 12001078.

5. Su CK, Bhattacharya J, Wang CC. Role of neck surgery in conjunction with radiation in regional control of node-positive cancer of the orophsarynx. Am J Clin Oncol. 2002; 25:109–116. PMID: 11943885.

6. Kramer S, Gelber RD, Snow JB, Marcial VA, Lowry LD, Davis LW, et al. Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73~03 of the Radiation Therapy Oncology Group. Head Neck Surg. 1987; 10:19–30. PMID: 3449477.

7. American Joint committee on Cancer. AJCC Cancer Staging Manual. 2002. ed 6. Philadelphia, PA: Lippincott-Raven.

8. SAS Institute Inc. Users guide: statistics version. 1985. 5th ed. Cary NC: SAS Institute.

9. Armitage P, Berry G. Statistical methods in medical research. 1987. 2nd ed. London: Blackwell Scientific Publications;p. 436–437.

10. Gardner NJ, Altman DG. Gardner NJ, Altman DG, editors. Calculation of confidence intervals for survival during analysis. Statistics with confidence. 1989. London: British Medical Journal Publications;p. 54–70.

11. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the radiation therpy oncology group (RTOG) and the european organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31:1341–1346. PMID: 7713792.

12. Foote RL, Schild SE, Thompson WM, Buskirk SJ, Olsen KD, Stanley RJ, et al. Tonsil cancer. Patterns of failure after surgery alone and surgery combined with postoperative radiation therapy. Cancer. 1994; 73:2638–2647. PMID: 8174064.

13. Wang MB, Kuber N, Kerner MM, Lee SP, Juilliard GF, Abemayor E. Tonsillar carcinoma: analysis of treatment results. J Otolaryngol. 1998; 27:263–269. PMID: 9800624.

14. Perez CA, Patel MM, Chao KS, Simpson JR, Sessions D, Spector GJ, et al. Carcinoma of the tonsillar fossa: prognostic factors and long-term therapy outcome. Int J Radiat Oncol Biol Phys. 1998; 42:1077–1084. PMID: 9869232.

15. Clayman GL, Weber RS, Guillamondegui O, Byers RM, Wolf PF, Frankenthaler RA, et al. Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers. Arch Otolaryngol Head Neck Surg. 1995; 121:219–223. PMID: 7840931.

16. Nathu RM, Mendenhall WM, Parsons JT, Mancuso AA, Carroll RR. Induction chemotherapy and radiation therapy for T4 oropharyngeal carcinoma. Radiat Oncol Investig. 1999; 7:98–105.

17. Wendt TG, Grabenbauer GG, Rodel CM, Thiel HJ, Aydin H, Rohloff R, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: a randomized multicenter study. J Clin Oncol. 1998; 16:1318–1324. PMID: 9552032.

18. Jeremic B, Shibamoto Y, Milicic B, Nikolic N, Dagovic A, Aleksandrovic J, et al. Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol. 2000; 18:1458–1464. PMID: 10735893.

19. Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998; 338:1798–1804. PMID: 9632446.

20. Adelstein DJ, Lavertu P, Saxton JP, Secic M, Wood BG, Wanamaker JR, et al. Mature results of a Phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer. 2000; 88:876–883. PMID: 10679658.

21. Pignon JP, Bourhis J, Domenge C, Designe L. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. Lancet. 2000; 355:949–955. PMID: 10768432.

22. Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst. 1999; 91:2081–2086. PMID: 10601378.

23. Lee GT, Byun JH, Hwangbo K, Mok JO, Kim ES, Won JH, et al. Comparison of radiation therapy and combined chemotherapy and radiation therapy for locally advanced head and neck cancer. J Korean Cancer Assoc. 1997; 29:616–622.

24. O'Sullivan B, Warde P, Grice B, Goh C, Payne D, Liu FF, et al. The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys. 2001; 51:332–343. PMID: 11567806.