1
|
Razavian NB, Waltonen JD, Steber CR, Shenker RF, May NH, Yang JH, Lanier CM, Greven KM, Frizzell BA, Hughes RT. Unilateral Neck Treatment with either Surgery and/or Radiotherapy for Squamous Cell Carcinoma for the Tonsil. ORL J Otorhinolaryngol Relat Spec 2024:1-11. [PMID: 39265554 DOI: 10.1159/000541390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/04/2024] [Indexed: 09/14/2024]
Abstract
INTRODUCTION Strategies for treatment of tonsil carcinoma are under active investigation. Limiting surgical and radiation treatment volumes to the primary tumor and ipsilateral neck in appropriately selected patients are one such approach. Here, we present our institutional experience with treatment through ipsilateral surgical or radiotherapeutic neck management. METHODS We retrospectively reviewed our institutional database of patients with tonsil carcinoma treated from 2012 to 2020. Patients were included for analysis if they received definitive radiation therapy (RT), definitive surgery (S), or surgery with postoperative radiation therapy (S-PORT) and whose treatment volumes were limited to the primary tumor and involved/elective ipsilateral neck. Patients who received radiation and/or surgery to the contralateral neck (including those with bilateral nodal involvement), as well as patients with metastatic disease, were excluded. Clinical factors including T- and N-stage (AJCC 7th edition), and HPV status (by p16 and/or HPV DNA PCR) were recorded, as were pathologic factors (when applicable) including margin status, extracapsular extension (ECE), lymphovascular invasion (LVSI), and perineural invasion (PNI). Overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) at 2 years were estimated using the Kaplan-Meier method. RESULTS In total, 71 patients were treated with unilateral neck approaches: S (n = 49), RT (n = 10), and S+PORT (n = 12). Among these patients, 32, 36, and 3 had T1, T2, and T3 disease, respectively. N-stage was N0, N1, N2a, N2b, and N3 in 22, 20, 5, 23, and 1 patient(s), respectively. Concurrent chemotherapy was administered in 12 patients. From those with recorded risk factors, 86% were HPV positive, 20% had LVSI, 7% had PNI, 13% had ECE, and 5% had positive margins. From a median follow-up of 27 months, local, regional, and distant failures occurred in 5, 6, and 5 patients, respectively. No contralateral neck failures were recorded. At 2 years, OS, PFS, and LRC were 92% (95% CI 85-99%), 85% (95% CI 75-95%), and 88% (95% CI 80-98%), respectively. CONCLUSIONS In patients with early T-stage tonsil carcinoma, treatment of the primary tumor and ipsilateral neck is associated with acceptable OS, PFS, and LRC. In this population, the risk of contralateral neck failure is likely very low regardless of primary treatment modality. Additional prospective studies are needed to determine the impact of limiting treatment extent, either surgical or radiotherapeutic, to the unilateral neck.
Collapse
Affiliation(s)
- Niema B Razavian
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA,
| | - Joshua D Waltonen
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Cole R Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nelson H May
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jae H Yang
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Claire M Lanier
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn M Greven
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bart A Frizzell
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
2
|
Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Friesland S. Dose Escalation of Oropharyngeal Cancer: Long-Time Follow-Up and Side Effects. Cancers (Basel) 2023; 15:cancers15092580. [PMID: 37174046 PMCID: PMC10177133 DOI: 10.3390/cancers15092580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Previous studies on dose-escalated radiotherapy in head and neck cancer have shown mixed results, and it is not established which patients would benefit from dose escalation. Further, while dose escalation does not appear to increase late toxicity, this needs to be confirmed with longer follow-up. In this study, we analysed treatment outcome and toxicity in 215 patients with oropharyngeal cancer treated with dose-escalated radiotherapy (>72 Gy, EQD2, α/β = 10 Gy, boost by brachytherapy or simultaneous integrated boost) and a matched cohort of 215 patients treated with standard dose external-beam radiotherapy (68 Gy) between 2011 and 2018 at our institution. The 5-year overall survival (OS) was 77.8% (72.4-83.6) and 73.7% (67.8-80.1) in the dose-escalated and standard dose group, respectively (p = 0.24). Median follow-up was 78.1 (49.2-98.4) and 60.2 (38.9-89.4) months in the dose-escalated and standard dose groups, respectively. Grade ≥3 osteoradionecrosis (ORN) and late dysphagia were more common in the dose-escalated group compared to the standard dose group, with 19 (8.8%) vs. 4 (1.9%) patients developing grade ≥3 ORN (p = 0.001), and 39 (18.1%) vs. 21 (9.8%) patients developing grade ≥3 dysphagia (p = 0.01). No predictive factors to help select patients for dose-escalated radiotherapy were found. However, the remarkably good OS in the dose-escalated cohort, despite a predominance of advanced tumour stages, encourages further attempts to identify such factors.
Collapse
Affiliation(s)
- Anna Embring
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
| | - Eva Onjukka
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Claes Mercke
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
| | - Ingmar Lax
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anders Berglund
- Epistat Epidemiology and Statistics Consulting, 75655 Uppsala, Sweden
| | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
| |
Collapse
|
3
|
Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Friesland S. Dose escalation in oropharyngeal cancer: a comparison of simultaneous integrated boost and brachytherapy boost. Radiat Oncol 2023; 18:65. [PMID: 37029424 PMCID: PMC10082532 DOI: 10.1186/s13014-023-02256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Local recurrence is the most common pattern of failure in head and neck cancer. It can therefore be hypothesised that some of these patients would benefit from an intensified local treatment, such as radiation dose escalation of the primary tumour. This study compares treatment and toxicity outcomes from two different boost modalities in oropharyngeal cancer: simultaneous integrated boost (SIB) and brachytherapy boost. METHODS Two hundred and forty-four consecutive patients treated with > 72 Gy for oropharyngeal squamous cell carcinoma between 2011 and 2018 at our institution were retrospectively analysed. Data on side effects were collected from a local quality registry and supplemented with a review of medical records. Patients receiving a brachytherapy boost first had external beam radiotherapy consisting of 68 Gy in 2 Gy fractions to the gross tumour volume (GTV), and elective radiotherapy to the neck bilaterally. The brachytherapy boost was typically given using pulsed dose rate, 15 fractions and 0.56-0.66 Gy per fraction [total dose in EQD2 = 75.4-76.8 Gy (α/β = 10)]. The typical dose escalated radiotherapy with external beam radiotherapy only, was delivered using SIB with 74,8 Gy in 2.2 Gy fractions [EQD2 = 76.0 Gy (α/β = 10)] to the primary tumour, 68 Gy in 2 Gy fractions to GTV + 10 mm margin and elective radiotherapy to the neck bilaterally. RESULTS Dose escalation by SIB was given to 111 patients and brachytherapy boost to 134 patients. The most common type of cancer was base of tongue (55%), followed by tonsillar cancer (42%). The majority of patients had T3- or T4-tumours and 84% were HPV-positive. The 5-year OS was 72,4% (95% CI 66.9-78.3) and the median follow-up was 6.1 years. Comparing the two different dose escalation modalities we found no significant differences in OS or PFS and these results remained after a propensity-score matched analysis was performed. The analysis of grade ≥ 3 side effects showed no significant differences between the two different dose escalation techniques. CONCLUSIONS We found no significant differences in survival or grade ≥ 3 side effects comparing simultaneous integrated boost and brachytherapy boost as alternative dose escalation modalities in the treatment of oropharyngeal cancer.
Collapse
Affiliation(s)
- Anna Embring
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden.
| | - Eva Onjukka
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Berglund
- Epistat Epidemiology and Statistics Consulting, Uppsala, Sweden
| | - Signe Friesland
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden
| |
Collapse
|
4
|
Straetmans JMJAA, Stuut M, Lacko M, Hoebers F, Speel EJM, Kremer B. Additional parameters to improve the prognostic value of the 8th edition of the UICC classification for human papillomavirus-related oropharyngeal tumors. Head Neck 2022; 44:1799-1815. [PMID: 35579041 PMCID: PMC9544856 DOI: 10.1002/hed.27084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background The prognostic reliability of the UICC's TNM classification (8th edition) for human papillomavirus (HPV)‐positive tonsillar squamous cell carcinomas (TSCCs) compared to the 7th edition was explored, and its improvement by using additional anatomical and nonanatomical parameters. Methods One hundred and ten HPV‐positive and 225 HPV‐negative TSCCs were retrospectively analyzed. Survival was correlated with patient and tumor characteristics (7th and 8th edition UICC TNM classification). Results In HPV‐positive TSCCs, the 8th edition UICC's TNM classification correlated better with prognosis than the 7th edition. Also, smoking status was a stronger prognosticator of survival than UICC staging. Non‐ or former smokers had a 5‐year overall survival of 95.1% regardless of tumor stage. Furthermore, age (>65 years), cN3, and M1 classification were significant prognostic factors. Conclusion The prognostic value of the 8th edition UICC's TNM classification improved significantly when compared to the 7th edition. Nonetheless, further improvement is possible by adding nonanatomical factors (smoking, age >65 year) and separating N0‐N2 from N3.
Collapse
Affiliation(s)
- Jos M J A A Straetmans
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Marijn Stuut
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
5
|
Nuyts S, Bollen H, Eisbruch A, Corry J, Strojan P, Mäkitie AA, Langendijk JA, Mendenhall WM, Smee R, DeBree R, Lee AWM, Rinaldo A, Ferlito A. Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck. Head Neck 2021; 43:2807-2821. [PMID: 33871090 DOI: 10.1002/hed.26713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022] Open
Abstract
Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high-dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment-related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT-guided nodal irradiation in squamous cell carcinomas of the head and neck.
Collapse
Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Avrahram Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - June Corry
- Division of Medicine, Department of Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Remco DeBree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Udine, Italy
| |
Collapse
|
6
|
Maschio F, Lejuste P, Ilankovan V. Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years. Br J Oral Maxillofac Surg 2019; 57:101-115. [PMID: 30665664 DOI: 10.1016/j.bjoms.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.
Collapse
Affiliation(s)
- F Maschio
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK; Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - P Lejuste
- Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - V Ilankovan
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK.
| |
Collapse
|
7
|
Chin RI, Rao YJ, Hwang MY, Spencer CR, Pierro M, DeWees T, Patel P, Sinha P, Gay HA, Daly M, Haughey BH, Nussenbaum B, Adkins DR, Lewis JS, Thorstad WL. Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer 2017; 123:4594-4607. [DOI: 10.1002/cncr.30931] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Re-I Chin
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Yuan James Rao
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Y. Hwang
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Christopher R. Spencer
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Michael Pierro
- Department of Internal Medicine; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Todd DeWees
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Pranav Patel
- Department of Internal Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Parul Sinha
- Division of Head and Neck Surgery; Department of Otolaryngology, Washington University School of Medicine; St. Louis Missouri
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Mackenzie Daly
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| | - Bruce H. Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration; Florida
| | - Brian Nussenbaum
- Division of Head and Neck Surgery; Department of Otolaryngology, Washington University School of Medicine; St. Louis Missouri
| | - Douglas R. Adkins
- Division of Hematology and Oncology; Department of Internal Medicine, Washington University School of Medicine; St. Louis Missouri
| | - James S. Lewis
- Department of Pathology; Microbiology, and Immunology, Vanderbilt University School of Medicine; Nashville Tennessee
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis Missouri
| |
Collapse
|
8
|
Elective unilateral nodal irradiation in head and neck squamous cell carcinoma: A paradigm shift. Eur J Cancer 2017. [DOI: 10.1016/j.ejca.2017.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
9
|
The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:259-264. [DOI: 10.1016/j.anorl.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
Song S, Wu HG, Lee CG, Keum KC, Kim MS, Ahn YC, Oh D, Park HJ, Lee SW, Park G, Moon SH, Cho KH, Kim YS, Won Y, Oh YT, Kim WT, Jeong JU. Chemoradiotherapy versus surgery followed by postoperative radiotherapy in tonsil cancer: Korean Radiation Oncology Group (KROG) study. BMC Cancer 2017; 17:598. [PMID: 28854890 PMCID: PMC5577763 DOI: 10.1186/s12885-017-3571-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/21/2017] [Indexed: 11/12/2022] Open
Abstract
Background Treatment of tonsil cancer, a subset of oropahryngeal cancer, varies between surgery and radiotherapy. Well-designed studies in tonsil cancer have been rare and it is still controversial which treatment is optimal. This study aimed to assess the outcome and failure patterns in tonsil cancer patients treated with either approaches. Methods We retrospectively reviewed medical records of 586 patients with tonsil cancer, treated between 1998 and 2010 at 16 hospitals in Korea. Two hundred and one patients received radiotherapy and chemotherapy (CRT), while 385 patients received surgery followed by radiotherapy and/or chemotherapy (SRT). Compared with the SRT group, patients receiving CRT were older, with more advanced T stage and received higher radiotherapy dose given by intensity modulation techniques. Overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and clinicopathologic factors were analyzed. Results At follow-up, the 5-year OS, DFS, LRRFS and DMFS rates in the CRT group were 82, 78, 89, and 94%, respectively, and in the SRT group were 81, 73, 87, and 89%, respectively. Old age, current smoking, poor performance status, advanced T stage, nodal involvement, and induction chemotherapy were associated with poor OS. Induction chemotherapy had a negative prognostic impact on OS in both treatment groups (p = 0.001 and p = 0.033 in the CRT and SRT groups, respectively). Conclusions In our multicenter, retrospective study of tonsil cancer patients, the combined use of radiotherapy and chemotherapy resulted in comparable oncologic outcome to surgery followed by postoperative radiotherapy, despite higher-risk patients having been treated with the definitive radiotherapy. Induction chemotherapy approaches combined with either surgery or definitive radiotherapy were associated with unfavorable outcomes. Electronic supplementary material The online version of this article (10.1186/s12885-017-3571-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sanghyuk Song
- Department of Radiation Oncology, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, 24289, Republic of Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mi Sun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hyo Jung Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Geumju Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Ho Moon
- Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Kwan Ho Cho
- Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yongkyun Won
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Gyeonggi, South Korea
| | - Won-Taek Kim
- Department of Radiation Oncology, Pusan National University Hospital and Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| |
Collapse
|
11
|
Naidu SI, Vieira F, Samant S, Vang MC, Wan AY, Robbins TK. Targeted Intra-Arterial Chemoradiation for Advanced Tonsil Cancer. Otolaryngol Head Neck Surg 2016; 133:882-7. [PMID: 16360508 DOI: 10.1016/j.otohns.2005.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Indexed: 01/29/2023]
Abstract
OBJECTIVES: To determine the effects of combined radiation and targeted, intra-arterial (IA) cisplatin infusions (RADPLAT) in patients with advanced squamous cell carcinoma (SCC) of the tonsil. STUDY DESIGN AND SETTING: Prospective study of treatment outcomes and toxicity of patients enrolled on the RADPLAT protocol, with specific analysis of patients with advanced SCC of the tonsil. RESULTS: Thirty patients with advanced tonsil carcinoma (17 T4, 12 T3, 1 T2) were enrolled, and 24 of 30 patients completed at least 3 IA cisplatin infusions and a minimum of 63 Gy or radiation therapy (minimum therapy). Two-year estimated overall and disease-specific survival was 42% and 50%, respectively, for all 30 patients (intent-to-treat group) and 49% and 58%, respectively, for the minimum therapy subgroup. The 2-year estimated local and regional disease control was 87% and 90%, respectively, for the intent-to-treat group, and 100% and 90% for the minimum therapy subgroup. Functional organ preservation was achieved in 92% of patients. CONCLUSIONS: Locoregional disease control achieved with this regimen appears to be significantly improved over that described in the literature for similarly staged tonsil cancer. Survival, on the other hand, remains comparable. EBM RATING: C
Collapse
Affiliation(s)
- Srikanth I Naidu
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee, Memphis, TN 38613, USA
| | | | | | | | | | | |
Collapse
|
12
|
Kennedy WR, Herman MP, Deraniyagala RL, Amdur RJ, Werning JW, Dziegielewski P, Kirwan J, Morris CG, Mendenhall WM. Radiotherapy alone or combined with chemotherapy as definitive treatment for squamous cell carcinoma of the tonsil. Eur Arch Otorhinolaryngol 2016; 273:2117-25. [PMID: 27059836 DOI: 10.1007/s00405-016-4027-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/31/2016] [Indexed: 01/08/2023]
Abstract
This study is aimed at updating our institution's experience with definitive radiotherapy (RT) for squamous cell carcinoma of the tonsil. We reviewed 531 patients treated between 1983 and 2012 with definitive RT for squamous cell carcinoma of the tonsil. Of these, 179 patients were treated with either induction (n = 19) or concomitant (n = 160) chemotherapy. Planned neck dissection was performed on 217 patients: unilaterally in 199 and bilaterally in 18 patients. Median follow-up was 5.2 years for all patients (range 0.1-31.6 years) and 8.2 years for living patients (range 1.9-31.6 years). The 5-year local control rates by T stage were as follows: T1, 94 %; T2, 87 %; T3 79 %; T4, 70 %; and overall, 83 %. Multivariate analysis revealed that local control was significantly influenced by T stage and neck dissection. The 5-year cause-specific survival rates by overall stage were as follows: I, 94 %; II, 88 %; III, 87 %; IVA, 75 %; IVB, 52 %; and overall, 78 %. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, N stage, overall stage, fractionation, neck dissection, sex, and ethnicity. Of 77 patients treated with ipsilateral fields only, contralateral neck failure occurred in 1 %. The rate of severe complications was 12 %. Definitive RT for patients with tonsillar squamous cell carcinoma provides control rates equivalent to other modalities with a comparatively low incidence of late complications. Patients with anterior tonsillar pillar or tonsillar fossa primaries that are well lateralized with no base of tongue or soft palate extension may be treated with ipsilateral fields.
Collapse
Affiliation(s)
- William R Kennedy
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Michael P Herman
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Rohan L Deraniyagala
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - John W Werning
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Peter Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jessica Kirwan
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA.,Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd., PO Box 100385, Gainesville, FL, 32610-0385, USA.
| |
Collapse
|
13
|
Laccourreye O, Malinvaud D, Holostenco V, Ménard M, Garcia D, Bonfils P. Value and limits of non-robotic transoral oropharyngectomy for local control of T1-2 invasive squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:141-6. [DOI: 10.1016/j.anorl.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Prognostic significance of tumour progression and human papillomavirus in advanced tonsillar cancer classified as stage IVa. The Journal of Laryngology & Otology 2014; 129:86-92. [PMID: 25482503 DOI: 10.1017/s0022215114003065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify clinical factors that can explain the differences in treatment outcome, and examine the value of human papillomavirus infection as a prognostic biomarker in stage IVa tonsillar carcinomas. METHODS Fifty-nine patients with tonsillar carcinoma classified as stage IVa were retrospectively analysed for survival outcomes according to various clinical factors. Human papillomavirus infection was evaluated using a human papillomavirus DNA chip test and immunohistochemical staining for p16 and p53. RESULTS Lower disease-free survival rates were associated with increasing local invasiveness and nodal status. Although human papillomavirus positivity and p16 expression was more common in locally advanced tonsillar carcinomas with advanced nodal status, the overall survival rate was better for patients with human papillomavirus positive, p16-positive tumours. CONCLUSION The disease-free survival rate may differ according to local tumour invasiveness and nodal status, even for stage IVa tonsillar cancers. Human papillomavirus infection may be a useful biomarker for predicting treatment outcomes for stage VIa tumours.
Collapse
|
15
|
Laccourreye O, Malinvaud D, Garcia D, Ménard M, Hans S, Cauchois R, Bonfils P. Postoperative Hemorrhage After Transoral Oropharyngectomy for Cancer of the Lateral Oropharynx. Ann Otol Rhinol Laryngol 2014; 124:361-7. [DOI: 10.1177/0003489414558109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Assessment of incidence, risk factors, management, and outcome of postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. Methods: Retrospective review of a cohort of 514 cancers of the lateral oropharynx consecutively resected. Results: Incidence of postoperative hemorrhage was 3.6%. In 31.5% of cases, onset was after hospital discharge. No hemorrhages occurred after the end of the fourth postoperative week. Variables associated with increased risk of hemorrhage were advanced age ( P = .004), antithrombotic treatment ( P = .012), and robotic assistance ( P = .009). When the source of hemorrhage could be identified, hemostasis, performed transorally in most cases, was highly effective; no patients in this subgroup showed recurrence. In spontaneously resolved hemorrhage under observation or when no active site of bleeding was found on exploration under general anesthesia, the recurrence rate was 18.1%. Overall, hemorrhage resulted in death in 2 patients. Conclusion: Exploration under general anesthesia in case of active bleeding and observation with discussion of arterial exploration of the ipsilateral external carotid system in patients in whom no source of bleeding can be identified are the keys to successful management of this potentially lethal complication.
Collapse
Affiliation(s)
| | - David Malinvaud
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | | | | | - Stéphane Hans
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Régis Cauchois
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Pierre Bonfils
- Université Paris Descartes Sorbonne Paris Cité, Paris, France
| |
Collapse
|
16
|
Rahmati R, Dogan S, Pyke O, Palmer F, Awad M, Lee N, Kraus DH, Shah JP, Patel SG, Ganly I. Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation. Head Neck 2014; 37:800-7. [PMID: 24616252 DOI: 10.1002/hed.23679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 01/09/2014] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). METHODS Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. RESULTS Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was not predictive of outcome (DSS 80% for N0 vs 82% for N+; p = .97). Lymphovascular invasion was an independent predictor of OS, DSS, and RFS on multivariate analysis. CONCLUSION Lymphovascular invasion but not pathological stage of the neck is an independent predictor of outcome in patients with tonsillar SCC.
Collapse
Affiliation(s)
- Rahmatullah Rahmati
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Owen Pyke
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,State University of New York - Stony Brook, School of Medicine, Stony Brook, New York
| | - Frank Palmer
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mahmoud Awad
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Dennis H Kraus
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.,Head and Neck Institute, North Shore Health System, Great Neck, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
17
|
Bastos de Souza TR, Pinto CAL, da Cunha Mercante AM, Nishimoto IN, Brasilino de Carvalho M, Kowalski LP. Long-term results of surgical treatment for advanced oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:1146-54. [PMID: 23897725 DOI: 10.1002/hed.23427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/29/2013] [Accepted: 06/26/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to review the oncologic and functional outcomes of patients with clinical stage III or IV squamous cell carcinoma (SCC) of the oropharynx submitted to tumor resection and neck dissection with or without postoperative radiotherapy (PORT). METHODS We conducted a retrospective review of medical charts of 256 consecutive patients. RESULTS Fatal postoperative complications were registered in 5 patients (1.9%). During follow-up, there were 74 local recurrences (29%), 27 neck recurrences (10.5%), and 19 distant metastases (7.4%). The 5-year overall survival (OS) was 43.0%. The Cox multivariate model identified pT3 and pT4, pN2 and pN3, and an intense lymphocytic infiltrate as independent prognostic markers for OS. The 5-year disease-free survival (DFS) rate was 54.5%. CONCLUSION Surgical treatment for oropharyngeal carcinoma can be performed with a low-risk of postoperative mortality but with a risk of long-term use of tracheostomy and feeding tubes.
Collapse
Affiliation(s)
- Tânia Regina Bastos de Souza
- Head and Neck Surgery and Otorhinolaryngology Department, Hospital A C Camargo, São Paulo, Brazil; Head and Neck Surgery Service, Hospital Heliopolis, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
18
|
Koo TR, Wu HG. Long-term results of ipsilateral radiotherapy for tonsil cancer. Radiat Oncol J 2013; 31:66-71. [PMID: 23865002 PMCID: PMC3712175 DOI: 10.3857/roj.2013.31.2.66] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/19/2013] [Accepted: 04/11/2013] [Indexed: 11/16/2022] Open
Abstract
Purpose We evaluated the effectiveness and safety of ipsilateral radiotherapy for the patient with well lateralized tonsil cancer: not cross midline and <1 cm of tumor invasion into the soft palate or base of tongue. Materials and Methods From 2003 to 2011, twenty patients with well lateralized tonsil cancer underwent ipsilateral radiotherapy. Nineteen patients had T1-T2 tumors, and one patient had T3 tumor; twelve patients had N0-N2a disease and eight patients had N2b disease. Primary surgery followed by radiotherapy was performed in fourteen patients: four of these patients received chemotherapy. Four patients underwent induction chemotherapy followed by concurrent chemoradiotherapy (CCRT). The remaining two patients received induction chemotherapy followed by radiotherapy and definitive CCRT, respectively. No patient underwent radiotherapy alone. We analyzed the pattern of failure and complications. Results The median follow-up time was 64 months (range, 11 to 106 months) for surviving patients. One patient had local failure at tumor bed. There was no regional failure in contralateral neck, even in N2b disease. At five-year, local progression-free survival, distant metastasis-free survival, and progression-free survival rates were 95%, 100%, and 95%, respectively. One patient with treatment failure died, and the five-year overall survival rate was 95%. Radiation Therapy Oncology Group grade 2 xerostomia was found in one patient at least 6 months after the completion of radiotherapy. Conclusion Ipsilateral radiotherapy is a reasonable treatment option for well lateralized tonsil cancer. Low rate of chronic xerostomia can be expected by sparing contralateral major salivary glands.
Collapse
Affiliation(s)
- Tae Ryool Koo
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | | |
Collapse
|
19
|
Lee H, Ahn YC, Oh D, Nam H, Kim YI, Park SY. Tumor volume reduction rate measured during adaptive definitive radiation therapy as a potential prognosticator of locoregional control in patients with oropharyngeal cancer. Head Neck 2013; 36:499-504. [PMID: 23780633 DOI: 10.1002/hed.23328] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) in patients with oropharyngeal cancer. METHODS We reviewed the RT records of 59 patients with oropharyngeal cancer who were treated with definitive RT with or without concurrent chemotherapy between January 2006 and October 2010. Adaptive replanning was performed in all patients during RT. The pre-RT and mid-RT gross tumor volumes (GTVs) of the primary and the metastatic lymph nodes were measured and analyzed for their possible impacts on locoregional control. RESULTS After the median follow-up period of 41.3 months (range, 9.3-73.5 months) for survivors, there were 10 treatment failures (8 locoregional recurrences and 2 distant metastases). The locoregional control rate at 3 years in all the patients was 84.1%. The mean pre-RT and mid-RT total GTVs were 27.5 cm(3) (±17.9 cm(3) ) and 16.9 cm(3) (±12.1 cm(3) ), and the mean GTV reduction rate was 37.9% (±22.6%), respectively. The patients who achieved locoregional control had a higher TVRR than those with locoregional failure (p = .010), and those with the TVRR >35% achieved significantly higher locoregional control at 3 years (94.4% vs 72.4%; p = .018). On multivariate analysis when adjusted with other clinical prognostic factors, the TVRR was found to be a significant factor affecting the locoregional control (hazard ratio = 0.136; 95% confidence interval = 0.022-0.852; p = .033). CONCLUSION The TVRR measured during adaptive RT proved a significant prognosticator on locoregional disease control in patients with oropharyngeal cancer, based on which a few therapeutic modifications may be considered.
Collapse
Affiliation(s)
- Hyebin Lee
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
20
|
Hinni ML, Zarka MA, Hoxworth JM. Margin mapping in transoral surgery for head and neck cancer. Laryngoscope 2013; 123:1190-8. [DOI: 10.1002/lary.23900] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Michael L. Hinni
- Department of Otolaryngology-Head and Neck Surgery; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
| | - Matthew A. Zarka
- Department of Laboratory Medicine and Pathology; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
| | - Joseph M. Hoxworth
- Department of Radiology; College of Medicine; Mayo Clinic; Phoenix; Arizona; U.S.A
| |
Collapse
|
21
|
Al-Mamgani A, van Rooij P, Fransen D, Levendag P. Unilateral neck irradiation for well-lateralized oropharyngeal cancer. Radiother Oncol 2013; 106:69-73. [PMID: 23324589 DOI: 10.1016/j.radonc.2012.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the impact of unilateral neck irradiation (UNI) of well-lateralized oropharyngeal cancer (OPC) on outcome and toxicity. MATERIALS AND METHODS Unilateral neck IMRT was applied to 185 consecutive patients with well-lateralized OPC (restricted to tonsillar fossa, soft palate with at least 1cm from midline or lateral pharyngeal wall). Endpoints were regional control (RC), local control (LC), disease-free survival (DFS), overall survival (OS), and toxicity. RESULTS Six regional failures were reported (3.2%); 2 were contralateral (1.1%). The 5-year Kaplan-Meier estimates of RC, LC, DFS, and OS were 96%, 91%, 84%, and 70%, respectively. Feeding tube was given to 11.3%. Chemotherapy was significantly predictive for toxicity. However, no patient was still feeding tube dependent 6 weeks after treatment. Overall grade 3 late toxicity was 2.2%. Grade 3 xerostomia was reported in only 1 patient while no patient developed grade 3 dysphagia. CONCLUSION This largest study on unilateral neck IMRT for well-lateralized OPC showed excellent outcome and favorable toxicity profile. Given the increasing incidence of OPC, especially among younger patients, and the favorable results reported in the current study and by other investigators, expanding the indications for UNI still needs to be further investigated in prospective, preferably, randomized trials.
Collapse
Affiliation(s)
- Abrahim Al-Mamgani
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|
22
|
Results of transoral laser microsurgery in 102 patients with squamous cell carcinoma of the tonsil. Eur Arch Otorhinolaryngol 2012; 270:2299-306. [PMID: 23274878 PMCID: PMC3699702 DOI: 10.1007/s00405-012-2335-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/14/2012] [Indexed: 12/13/2022]
Abstract
The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13% presented with stage I and II (UICC/AJCC 2002) tumors and 87% with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95%) and with (66%) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan-Meier local and loco-regional control was 78% for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan-Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59% for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.
Collapse
|
23
|
Ahn S, Kim J, An C, Choi H, Lee SK, Koh Y, Kim SH, Choi E. Preoperative imaging evaluation of head and neck cancer: Comparison of 2D spin-echo and 3D THRIVE MRI techniques with resected tumours. Clin Radiol 2012; 67:e98-e104. [DOI: 10.1016/j.crad.2012.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/08/2012] [Accepted: 08/14/2012] [Indexed: 11/24/2022]
|
24
|
Broglie MA, Soltermann A, Haile SR, Röösli C, Huber GF, Schmid S, Stoeckli SJ. Quality of life of oropharyngeal cancer patients with respect to treatment strategy and p16-positivity. Laryngoscope 2012; 123:164-70. [DOI: 10.1002/lary.23622] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/12/2022]
|
25
|
Krstevska V, Stojkovski I, Zafirova-Ivanovska B. Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors. Radiat Oncol 2012; 7:78. [PMID: 22640662 PMCID: PMC3404949 DOI: 10.1186/1748-717x-7-78] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category. METHODS Sixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m(2)) started at the first day of radiotherapy. RESULTS Median age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively). CONCLUSIONS Poor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.
Collapse
Affiliation(s)
- Valentina Krstevska
- Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia
| | - Igor Stojkovski
- Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia
| | - Beti Zafirova-Ivanovska
- Institute of Epidemiology, Statistics and Informatics, Faculty of Medicine, Skopje, Macedonia
| |
Collapse
|
26
|
Yeung AR, Garg MK, Lawson J, McDonald MW, Quon H, Ridge JA, Saba N, Salama JK, Smith RV, Yom SS, Beitler JJ. ACR appropriateness criteria® ipsilateral radiation for squamous cell carcinoma of the tonsil. Head Neck 2012; 34:613-6. [DOI: 10.1002/hed.21993] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2011] [Indexed: 11/06/2022] Open
|
27
|
Genden EM, Kotz T, Tong CCL, Smith C, Sikora AG, Teng MS, Packer SH, Lawson WL, Kao J. Transoral robotic resection and reconstruction for head and neck cancer. Laryngoscope 2011; 121:1668-74. [DOI: 10.1002/lary.21845] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
28
|
Röösli C, Studer G, Stoeckli SJ. Salvage treatment for recurrent oropharyngeal squamous cell carcinoma. Head Neck 2010; 32:989-96. [PMID: 19953618 DOI: 10.1002/hed.21273] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy +/- chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy +/- chemotherapy. METHODS A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). RESULTS The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. CONCLUSIONS Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases.
Collapse
Affiliation(s)
- Christof Röösli
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
| | | | | |
Collapse
|
29
|
Aziz L, Nyman J, Edström S. T but not N stage predicts survival for patients with tonsillar carcinoma treated with external radiotherapy and brachytherapy. Acta Oncol 2010; 49:821-5. [PMID: 20615169 DOI: 10.3109/02841860903490085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Our aim was to determine the efficacy of a therapeutic schedule including external radiation and brachytherapy in a consecutive and retrospective series of tonsillar carcinoma patients. PATIENTS AND METHODS Ninety-six patients with tonsillar carcinoma were treated between 1988 and 2000 and were followed up for at least for three years. All patients were treated with accelerated hyperfractionated external radiotherapy, 68 patients had additional brachytherapy and 69 patients with advanced stages also received chemotherapy. There was no planned surgery even though 73% had N+ disease. Eleven patients with persistent neck nodes underwent ultimate salvage surgery. RESULTS The overall three-year survival (OS) was 70%. OS for the T stage was T1 90%, T2 89%, T3 54% and T4 60%. The corresponding numbers for the N stage were N0 61.5%, N1 73%, N2 78% and N3 66%. Accordingly OS was influenced by the T stage (p>0.001) rather than by N stage. Only four patients with salvage surgery had viable tumour cells in the specimen, their survival was not inferior. DISCUSSION The primary tumour stage is an essential determinant for survival in patients with irradiated tonsillar carcinoma. Neck dissection should be confined only as a salvage procedure.
Collapse
Affiliation(s)
- Luaay Aziz
- Department of Otorhinolaryngology, Head & Neck Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
| | | | | |
Collapse
|
30
|
Yildirim G, Morrison WH, Rosenthal DI, Sturgis EM, Papadimitrakopoulou VA, Schwartz DL, Garden AS. Outcomes of patients with tonsillar carcinoma treated with post-tonsillectomy radiation therapy. Head Neck 2010; 32:473-80. [PMID: 19691110 DOI: 10.1002/hed.21207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the therapeutic outcomes of patients with squamous cell carcinoma of the tonsil that underwent tonsillectomies followed by radiotherapy. METHODS A search of the database maintained within the Department of Radiation Oncology at The University of Texas M. D. Anderson Cancer Center identified 120 patients with carcinoma of the tonsil who were irradiated between 1979 and 2004 following total gross removal of their disease by tonsillectomy. RESULTS Thirty-six patients had stage III disease and 64 patients had stage IV disease. Only 12 patients received systemic chemotherapy. With median follow-up of 51 months, the 5-year local-regional control rate, recurrence-free survival rate, and overall survival rates were 97%, 92%, and 86%, respectively. CONCLUSION Patients who undergo tonsillectomies resulting in total gross removal of their primary disease followed by radiation have excellent outcomes. Our common practice is to deliver 66 Gy to the tonsillar bed. This practice has resulted in extremely high local control rates.
Collapse
Affiliation(s)
- Gokcen Yildirim
- The University of Texas M. D. Anderson Cancer Center, Department of Radiation Oncology, Unit 97, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
Clinical Nodal Staging of T1-2 Tonsillar Squamous Cell Carcinoma Stratified by p16 Status and Implications for Ipsilateral Neck Irradiation. Cancer J 2010; 16:284-7. [DOI: 10.1097/ppo.0b013e3181ddd088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Agarwal JP, Mallick I, Bhutani R, Ghosh-Laskar S, Gupta T, Budrukkar A, Murthy V, Sengar M, Dinshaw KA. Prognostic factors in oropharyngeal cancer--analysis of 627 cases receiving definitive radiotherapy. Acta Oncol 2010; 48:1026-33. [PMID: 19363712 DOI: 10.1080/02841860902845839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this retrospective analysis was to analyze the results of conventional radical radiotherapy in the treatment of oropharyngeal cancer and to identify pre-treatment and treatment-related prognostic factors for outcome. MATERIAL AND METHODS The records of 627 patients with oropharyngeal cancer treated with radical radiotherapy with conventional techniques were analyzed. RESULTS The median age was 56 years. History of tobacco abuse was present in 80.5%. Eighty six percent had stage III or IV disease. Radical radiotherapy alone was the treatment modality for 71.2% and concomitant or neoadjuvant chemotherapy was used in 28.8%. The 3-year local control (LC), loco-regional control (LRC), disease-free survival (DFS) and overall survival (OS) was 49%, 40.6%, 38.9% and 36.1% respectively. The 3-year DFS rates were 80.3% for stage I, 65.8% for stage II, 46.1% for stage III and 25.2% for stage IV disease. Multivariate analysis was performed for prognostic factors. Prior history of tobacco abuse was an independent prognostic factor for both DFS and LRC. Karnofsky Performance Score (KPS) < 80, higher nodal stage, lower total radiotherapy dose (<66 Gy) in those receiving > 60 Gy, and overall treatment time > 50 days were other independent prognostic factors for inferior DFS and LRC. KPS < 80, higher T stage, higher nodal stage, RT dose < 66 Gy and longer overall treatment time (>50 days) were independent prognostic factors for poorer local control. CONCLUSIONS Several patient-, disease- and treatment-related variables independently affect survival outcomes after radical radiotherapy for oropharyngeal cancer. Oropharyngeal cancers in those without a history of tobacco abuse may be biologically different and more amenable to cure with radiotherapy.
Collapse
|
33
|
Pretreatment prognostic factors of survival in patients with locally advanced nonmetastatic squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy. Am J Clin Oncol 2009; 32:163-8. [PMID: 19307954 DOI: 10.1097/coc.0b013e31818254cc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification of pretreatment prognostic factors influencing overall survival (OS) in locally advanced squamous cell carcinoma of the head and neck is an important issue in head and neck oncology. METHODS A total of 289 patients were treated with standard fraction or hyperfractionated radiation therapy with or without concurrent low-dose daily chemotherapy. RESULTS Gender (P = 0.43) and age (P = 0.26) did not influence OS whereas Karnofsky Performance Status (KPS) (P < 0.0001), T stage (P < 0.0001), and N stage (P < 0.0001) did. Stage grouping was another factor that influenced OS (P < 0.001). Patients with larynx and nasopharynx fared better than those with other primaries (P = 0.0153). Finally, treatment significantly influenced OS. Multivariate analysis showed that KPS, T and N stage, and treatment were independent prognosticators of OS. CONCLUSIONS KPS, T and N stage, and treatment are independent prognosticators of OS in patients with locally advanced squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent low-dose daily chemotherapy.
Collapse
|
34
|
Treatment Outcomes of T4 Locally Advanced Head and Neck Cancers With Soft Tissue Invasion or Bone and Cartilage Invasion. Am J Clin Oncol 2009; 32:477-82. [PMID: 19506456 DOI: 10.1097/coc.0b013e31819380a8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
La TH, Filion EJ, Turnbull BB, Chu JN, Lee P, Nguyen K, Maxim P, Quon A, Graves EE, Loo BW, Le QT. Metabolic tumor volume predicts for recurrence and death in head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 74:1335-41. [PMID: 19289263 PMCID: PMC2752334 DOI: 10.1016/j.ijrobp.2008.10.060] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the prognostic value of metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and other clinical factors in patients treated for locally advanced head-and-neck cancer (HNC) at a single institution. MATERIALS AND METHODS Between March 2003 and August 2007, 85 patients received positron emission tomography (PET)/computed tomography-guided chemoradiotherapy for HNC. Metabolically active tumor regions were delineated on pretreatment PET scans semiautomatically using custom software. We evaluated the relationship of (18)F-fluorodeoxyglucose-PET maximum standardized uptake value (SUV) and total metabolic tumor volume (MTV) with disease-free survival (DFS) and overall survival (OS). RESULTS Mean follow-up for surviving patients was 20.4 months. The estimated 2-year locoregional control, DFS, and OS for the group were 88.0%, 69.5%, and 78.4%, respectively. The median time to first failure was 9.8 months among the 16 patients with relapse. An increase in MTV of 17.4 mL (difference between the 75th and 25th percentiles) was significantly associated with an increased hazard of first event (recurrence or death) (1.9-fold, p < 0.001), even after controlling for Karnofsky performance status (KPS) (1.8-fold, p = 0.001), and of death (2.1-fold, p < 0.001). We did not find a significant relationship of maximum SUV, stage, or other clinical factors with DFS or OS. CONCLUSIONS Metabolic tumor volume is an adverse prognostic factor for disease recurrence and death in HNC. MTV retained significance after controlling for KPS, the only other significant adverse prognostic factor found in this cohort. MTV is a direct measure of tumor burden and is a potentially valuable tool for risk stratification and guiding treatment in future studies.
Collapse
Affiliation(s)
- Trang H. La
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Edith J. Filion
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Brit B. Turnbull
- Department of Health Research and Policy (Division of Biostatistics), Stanford University, Stanford, CA
| | - Jackie N. Chu
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Percy Lee
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Khoa Nguyen
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Peter Maxim
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Andy Quon
- Department of Nuclear Medicine, Stanford University, Stanford, CA
| | - Edward E. Graves
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA
| |
Collapse
|
36
|
Röösli C, Tschudi DC, Studer G, Braun J, Stoeckli SJ. Outcome of patients after treatment for a squamous cell carcinoma of the oropharynx. Laryngoscope 2009; 119:534-40. [DOI: 10.1002/lary.20033] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
37
|
Rusthoven KE, Raben D, Schneider C, Witt R, Sammons S, Raben A. Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: results of a prospective management approach. Int J Radiat Oncol Biol Phys 2009; 74:1365-70. [PMID: 19168295 DOI: 10.1016/j.ijrobp.2008.10.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/03/2008] [Accepted: 10/08/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE To review the outcomes of a prospective management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion. METHODS AND MATERIALS Between August 2003 and June 2007, 20 patients who presented with squamous cell carcinoma of the tonsil, without involvement of the base of the tongue or midline soft palate, and with Stage N1-N2b disease were prospectively treated with radiotherapy to the primary site and ipsilateral neck. In addition, 18 patients received concurrent chemotherapy. The actuarial freedom from contralateral nodal and in-field progression was determined. Acute and late toxicity were prospectively evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3, and Radiation Therapy Oncology Group criteria. RESULTS The nodal disease was Stage N1 in 4 patients, N2a in 3 patients, and N2b in 13 patients. At a median follow-up 19 months (range, 12-40), no in-field or contralateral nodal recurrences had been observed. The 2-year freedom from distant metastasis rate was 87.4%. The actuarial 2-year disease-free and overall survival rates were both 79.5%. Late Radiation Therapy Oncology Group grade 2 xerostomia occurred in 1 patient (5%). No late Grade 3 or greater toxicity was observed. No patient was feeding tube dependent at their last follow-up visit. CONCLUSION In carefully selected patients with node-positive, lateralized tonsillar cancer, treatment of the ipsilateral neck and primary site does not appear to increase the risk of contralateral nodal failure and reduces late morbidity compared with historical controls. Although the outcomes with ipsilateral radiotherapy in the present series were promising, these findings require longer follow-up and validation in a larger patient cohort.
Collapse
Affiliation(s)
- Kyle E Rusthoven
- Department of Radiation Oncology, University of Colorado Health Sciences Center, Denver, Colorado 80045-0508, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Lim Y, Hong H, Baek S, Park J, Kim G, Lee C, Lew D, Lee W, Choi E. Combined surgery and postoperative radiotherapy for oropharyngeal squamous cell carcinoma in Korea: analysis of 110 cases. Int J Oral Maxillofac Surg 2008; 37:1099-105. [DOI: 10.1016/j.ijom.2008.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Revised: 12/11/2007] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
|
39
|
Lin HY, Jen YM, Liu DW, Hwang JM, Lee MS, Hung SK, Chao HL, Lin CS, Shum WY. The Role of Primary Surgery in Resectable Stage III/IV Tonsillar Carcinoma. Tzu Chi Med J 2008. [DOI: 10.1016/s1016-3190(08)60008-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
40
|
Hodge CW, Bentzen SM, Wong G, Palazzi-Churas KL, Wiederholt PA, Gondi V, Richards GM, Hartig GK, Harari PM. Are we influencing outcome in oropharynx cancer with intensity-modulated radiotherapy? An inter-era comparison. Int J Radiat Oncol Biol Phys 2007; 69:1032-41. [PMID: 17967300 DOI: 10.1016/j.ijrobp.2007.05.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 05/01/2007] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To analyze the outcome in all oropharynx cancer patients treated at the University of Wisconsin during 1995-2005 and highlight the methodologic challenge in comparing outcome after intensity-modulated radiotherapy (IMRT) with that of historical controls. METHODS AND MATERIALS Outcomes were compared in 195 oropharynx cancer patients after definitive radiotherapy with curative intent in the pre-IMRT era (pre-IMRT, n = 105), after IMRT (IMRT+, n = 52) or after non-IMRT techniques during the IMRT era (IMRT-, n = 38). RESULTS With a median follow-up of 30.4 months, the 3-year overall survival rate in IMRT+, IMRT-, and pre-IMRT patients was 88.2%, 81.1%, and 67.7%, respectively; and for locoregional control was 96.1%, 78.1%, and 81.1%. Patients from the IMRT era more frequently received concurrent chemotherapy (67% vs. 6%, p < 0.001) and underwent adjuvant neck dissection (52% vs. 29%, p = 0.002). Patients with T3-4 disease and bilateral neck disease were significantly less likely to receive IMRT. Cox regression analysis identified IMRT as a significant prognostic factor (p = 0.04); however, after including T stage in the model, IMRT lost independent significance (p = 0.2). Analysis of a potential effect of IMRT on Grade 3+ mucositis or skin reaction was also hampered by the change in other treatment characteristics. CONCLUSIONS Outcomes in oropharynx cancer have improved at our institution since the introduction of IMRT. However, multiple factors have contributed to this improvement, and presentation of IMRT outcomes without the full context of historical and contemporary controls may yield data that overstate outcome after IMRT.
Collapse
Affiliation(s)
- C Wesley Hodge
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Jensen K, Overgaard M, Grau C. Morbidity after ipsilateral radiotherapy for oropharyngeal cancer. Radiother Oncol 2007; 85:90-7. [PMID: 17604141 DOI: 10.1016/j.radonc.2007.06.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 06/04/2007] [Accepted: 06/05/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radiotherapy for oropharyngeal cancer often causes severe side effects. If the primary tumour is localized to the tonsillar region, elective irradiation may be limited to the ipsilateral neck, sparring the contralateral normal tissues. We wanted to study the consequences of volume sparring on all prospectively registered morbidity endpoints. METHODS AND PATIENTS Medical records, treatment charts and database information were collected for all 158 oropharynx cancer patients treated from 1998 to 2002 at Aarhus University Hospital. Of the 139 patients treated with curative intent 40 were treated with an ipsilateral technique. RESULTS Primary tumour extension outside the tonsillar fossa and T-stage were the only patient-, disease- and treatment related factors that differed between ipsilaterally and bilaterally treated patients. Loco-regional control and survival were not negatively influenced by the volume sparring technique. Side effects were reduced, in the ipsilaterally treated group, for all endpoints: xerostomia, dysphagia, hoarseness, atrophy, fibrosis and oedema. The number of patients experiencing moderate to severe toxicity was more than halved with ipsilateral treatment for all endpoints except fibrosis. CONCLUSION For selected patients with tonsillar cancer without involvement of midline structures, ipsilateral treatment is safe and reduces morbidity compared with bilateral treatment.
Collapse
Affiliation(s)
- Kenneth Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | | | | |
Collapse
|
42
|
Outcome of multimodal treatment for oropharyngeal carcinoma: A single institution experience. Oral Oncol 2007; 43:402-7. [DOI: 10.1016/j.oraloncology.2006.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 04/19/2006] [Accepted: 04/21/2006] [Indexed: 11/17/2022]
|
43
|
Preuss SF, Klussmann JP, Wittekindt C, Damm M, Semrau R, Drebber U, Guntinas-Lichius O. Long-term results of the combined modality therapy for advanced cervical metastatic head and neck squamous cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2007; 33:358-63. [PMID: 17157472 DOI: 10.1016/j.ejso.2006.10.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Accepted: 10/27/2006] [Indexed: 11/18/2022]
Abstract
AIM A consensus treatment strategy for advanced cervical metastatic head and neck squamous cell carcinoma has not been established. The aim of this retrospective study was to investigate the outcome of these patients uniformely using a strategy which consists of surgery for the primary tumor and the neck metastases followed by postoperative radio(chemo)therapy. METHODS We included a selected series of 518 patients with previously untreated head and neck squamous cell carcinoma. The overall survival (OS), the disease specific survival (DSS), the disease free survival (DFS), the local control (LC) and regional control (RC) estimates were calculated. The statistical relationship of various clinical and histopathological variables on the above mentioned estimates were analyzed. RESULTS The overall survival probability was 73.2% for pN0 stage, 43% for pN>1 stages and 31% for pN2c/pN3 stages. The pN stage significantly influenced the survival probabilities in oropharyngeal (p=0.0001) and laryngeal tumors (p<0.0001) in univariate analyses. In multivariate analysis, age, pT stage, pN stage, M stage, and extranodal spreading were independent risk factors for decreased disease-specific survival. CONCLUSIONS We could show that pN stage is an important independent prognostic factor in head and neck cancer. The presented multimodal treatment protocol provides excellent oncological outcomes and should therefore be standard of care for patients with operable advanced cervical metastatic head and neck squamous cell carcinoma.
Collapse
Affiliation(s)
- S F Preuss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical School, University of Cologne, Josef Stelzmann Str. 9, 50924 Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
44
|
Chen J, Pappas L, Moeller JH, Rankin J, Sharma PK, Bentz BG, Fang LC, Hayes JK, Shrieve DC, Hitchcock YJ. Treatment of oropharyngeal squamous cell carcinoma with external beam radiation combined with interstitial brachytherapy. Head Neck 2007; 29:362-9. [PMID: 17163468 DOI: 10.1002/hed.20528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We reviewed the outcomes of oropharyngeal squamous cell carcinoma treated with external beam radiation and interstitial brachytherapy. METHODS Ninety patients with squamous cell carcinoma of the oropharynx were treated with interstitial brachytherapy at the University of Utah between 1984 and 2001. Seventy-two patients received external beam radiotherapy (EBRT) followed by brachytherapy boost, 11 had surgery followed by EBRT and brachytherapy, 4 had surgery and brachytherapy, and 3 were treated with brachytherapy alone. Median doses for EBRT and brachytherapy were 50 and 24 Gy, respectively. RESULTS Median follow-up after brachytherapy was 48.3 months for all patients. Five-year local control, disease-free survival, and overall survival were 76%, 61%, and 55%. For T1, T2, T3, and T4, 5-year local control rates were 83%, 79%, 79%, and 64%, respectively. Severe complications occurred in 13 patients, including 2 treatment-related deaths. CONCLUSIONS EBRT combined with interstitial brachytherapy provide good local control rates for locally advanced oropharyngeal squamous cell carcinoma.
Collapse
Affiliation(s)
- Jergin Chen
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Malyapa RS, Werning JW, Lansford CD, Villaret DB. Definitive radiotherapy for tonsillar squamous cell carcinoma. Am J Clin Oncol 2006; 29:290-7. [PMID: 16755183 DOI: 10.1097/01.coc.0000209510.19360.f9] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to update our experience with definitive radiotherapy (RT) for carcinoma of the tonsillar area. PATIENTS AND METHODS There were 503 patients treated between October 1964 and May 2003 (potential follow-up for at least 2 years). Of these, 198 patients underwent a planned neck dissection and 57 patients received induction (18 patients) or concomitant (39 patients) chemotherapy. RESULTS The 5-year local control rates were as follows: T1, 88%; T2, 84%; T3, 78%; and T4, 61%. Multivariate analysis revealed that local control was significantly influenced by T stage, primary site, and fractionation. Local control after RT for early stage cancers was higher for tonsillar fossa/posterior pillar tumors than for those arising from the anterior tonsillar pillar. The 5-year cause-specific survival rates were as follows: I, 100%; II, 86%; III, 84%; IVA, 73%; and IVB, 46%. Multivariate analysis revealed that cause-specific survival was significantly influenced by T stage, overall stage, neck dissection, race, and gender. The incidence of severe late complications was 9%. CONCLUSION Based on our data and a review of the literature, definitive RT provides cure rates that are as good as those after surgery, and is associated with a lower rate of severe complications. Patients with lateralized tumors may be safely treated with ipsilateral field arrangements. Our limited experience with intensity modulated radiotherapy suggests that it is as efficacious as conventional RT.
Collapse
Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Yang MH, Chiang WC, Chou TY, Chang SY, Chen PM, Teng SC, Wu KJ. Increased NBS1 expression is a marker of aggressive head and neck cancer and overexpression of NBS1 contributes to transformation. Clin Cancer Res 2006; 12:507-15. [PMID: 16428493 DOI: 10.1158/1078-0432.ccr-05-1231] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) represents the sixth most frequent type of cancer worldwide. However, the molecular genetic alterations underlying its malignant behavior and progression are little known. We showed previously that c-MYC directly activates the expression of the DNA double-strand break repair gene NBS1, and NBS1 overexpression contributes to transformation. Here, we investigate the role of NBS1 overexpression in HNSCC. EXPERIMENTAL DESIGN Immunohistochemistry analysis of NBS1 expression was done in 81 locally advanced HNSCC patients. Real-time PCR and Western blot analysis were used to confirm immunohistochemistry results. Human hypopharyngeal cancer cell lines (FADU) with overexpressing NBS1 (FADUNBS) or inducible short interference RNA to repress endogenous NBS1 (FADUNBSi) were generated by stable transfection. Soft agar clonogenicity assay was used to determine the transformation activity. Western blot analysis and phosphatidylinositol 3-kinase (PI3K) assay were done to evaluate the signaling pathways that were involved. RESULTS NBS1 overexpression was identified in 45% of advanced HNSCC patients. It was an independent marker of poor prognosis. NBS1 expression levels correlated with the transformation activity of FADU clones and also correlated with the phosphorylation levels of Akt and its downstream target mammalian target of rapamycin (mTOR). PI3K activity was increased in NBS1-overexpressing FADU clones. NBS1 overexpression also correlated with increased Akt phosphorylation levels in tumor samples. CONCLUSIONS Increased NBS1 expression is a significant prognostic marker of advanced HNSCC, and the underlying mechanism may involve the activation of the PI3K/Akt pathway.
Collapse
Affiliation(s)
- Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No. 155 Li-Nong Street Sec. 2, Peitou, Taipei 112, Taiwan
| | | | | | | | | | | | | |
Collapse
|
47
|
Shirazi HA, Sivanandan R, Goode R, Fee WE, Kaplan MJ, Pinto HA, Goffinet DR, Le QT. Advanced-staged tonsillar squamous carcinoma: Organ preservation versus surgical management of the primary site. Head Neck 2006; 28:587-94. [PMID: 16475199 DOI: 10.1002/hed.20372] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Our aim was to review our experience in the management of advanced tonsillar squamous cell carcinoma (SCC) and to compare treatment outcomes between patients treated with and without surgery to the primary site. METHODS The records of 74 patients with advanced-stage tonsillar SCC were reviewed. The median age at diagnosis was 58 years. Thirty-eight patients received definitive surgery to the primary site, and 36 were treated with an organ-preservation approach (OP) using radiotherapy +/- chemotherapy. RESULTS No significant difference in overall survival (OS) or freedom from relapse (FFR) by treatment was found. T classification and N status were significant independent predictors on multivariate analysis for OS and FFR. Major late toxicity was noted in 10 patients in the surgical group and nine in the OP group. CONCLUSION Patients treated with OP and primary surgery had comparable OS and FFR. T classification and N status were significant independent predictors for tumor relapse and survival. On the basis of these results, we favor organ-preservation therapy for patients with advanced-stage tonsillar SCC.
Collapse
Affiliation(s)
- Haider Ali Shirazi
- Department of Radiation Oncology, 875 Blake Wilbur Dr, R. CC-G228, Stanford University, Stanford, CA 94305, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Le Scodan R, Pommier P, Ardiet JM, Montbarbon X, Malet C, Favrel V, Zrounba P, Poupart M, Céruse P, Ferlay C, Clippe S. Exclusive brachytherapy for T1 and T2 squamous cell carcinomas of the velotonsillar area: Results in 44 patients. Int J Radiat Oncol Biol Phys 2005; 63:441-8. [PMID: 16168837 DOI: 10.1016/j.ijrobp.2005.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 02/03/2005] [Accepted: 02/03/2005] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the role of interstitial brachytherapy as an exclusive radiotherapy modality for primary T1-T2 squamous cell carcinomas (SCC) of the velotonsillar area. METHODS AND MATERIALS Between 1992 and 2000, 44 patients with T1-T2 SCC of the tonsil (n = 36) and soft palate (n = 8) were treated to the primary with brachytherapy alone (37 patients) or after a limited resection (7 patients). Eight patients had prior external beam radiation therapy (EBRT) for previous head-and-neck carcinoma. Nineteen patients had initial neck dissection. The mean brachytherapy dose was 58.7 Gy, and the mean reference dose rate and Ir-192 linear activity were 58.2 cGy/h and 1.51 mCi/cm respectively. RESULTS With a 75-month median follow-up, 1 patient recurred locally. Isolated nodal relapses occurred in 4 patients, none of whom had initial neck dissection, and salvage therapy was successful in 2. Five-year overall and progression-free survival rates were 76% and 68%, respectively. Full-course radiation therapy was possible in 7 of 12 patients who developed a second primary head-and-neck carcinoma. Late toxicity was limited to 6 mild soft-tissue necroses, and was significantly associated with previous surgery to the primary and high linear activity. CONCLUSIONS Exclusive brachytherapy for T1-T2 velotonsillar carcinomas is safe and effective, and permits definitive reirradiation for a second head-and-neck cancer. Initial neck dissection should be performed for optimal selection for exclusive brachytherapy.
Collapse
Affiliation(s)
- Romuald Le Scodan
- Department of Radiation Oncology, Centre Léon Bérard, 28 rue Laennec, 69373 Lyon Cedex 08, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Chang AR, Wu HG, Park CI, Kim KH, Sung MW, Heo DS. Retrospective analysis of the treatment results for patients with squamous cell carcinoma of tonsil. Cancer Res Treat 2005; 37:92-7. [PMID: 19956486 DOI: 10.4143/crt.2005.37.2.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 02/15/2005] [Indexed: 11/21/2022] Open
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.
Collapse
Affiliation(s)
- Ah Ram Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
50
|
Selek U, Garden AS, Morrison WH, El-Naggar AK, Rosenthal DI, Ang KK. Radiation therapy for early-stage carcinoma of the oropharynx. Int J Radiat Oncol Biol Phys 2004; 59:743-51. [PMID: 15183477 DOI: 10.1016/j.ijrobp.2003.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2003] [Revised: 12/01/2003] [Accepted: 12/02/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the outcomes of radiation therapy treatment of patients with Stage I and II squamous cell carcinoma (SCC) of the oropharynx and discover adverse prognostic factors that may help select a subgroup of patients for a different management approach. METHODS AND MATERIALS A search of the database maintained by the Department of Radiation Oncology of The University of Texas M. D. Anderson Cancer Center for patients with Stage I or II SCC of the oropharynx was performed. This search identified 175 patients treated between 1970 and 1998 who met the inclusion criteria for this retrospective study. Distribution of primary sites was: tonsillar fossa/pillar, 60 patients; soft palate, 55 patients; base of tongue, 40 patients; and pharyngeal wall, 20 patients. Twenty-five patients were stage T1, 124 were T2, and 26 were Tx. All patients were treated with fractionated radiation to a median dose of 66 Gy. Eighty-five patients were treated with conventionally fractionated radiation, 73 were treated with the concomitant boost fractionation schedule, and the remaining 17 were treated with other altered fractionation schedules or with intraoral or interstitial boosts. RESULTS The median follow-up for all patients was 76 months (range, 2-302 months). The actuarial 5-year local control (LC), regional control, locoregional control (LRC), and disease-free survival (DFS) rates were 85%, 93%, 81%, and 77%, respectively. Only 7 patients (5%) with LC developed nodal metastases, and 10 patients (7%) with LRC developed distant metastases. Eleven patients (32%) with locoregional recurrence were rendered without evidence of disease after a surgical salvage procedure, resulting in a 5- year ultimate LRC rate of 87%. T-stage classification was statistically significant (p = 0.03) in univariate analysis for actuarial 5-year LRC, 88% for Stage I vs. 72% for Stage II. The 5- and 10-year disease-specific survival rates were 85% and 79%, respectively, while the actuarial 5- and 10-year overall survival rates were 70% and 43%, respectively. Fifty-one patients (29%) developed second primary tumors, 86% of which were cancers of the upper aerodigestive tract (UADT). Heavy alcohol consumption was associated with both an increased risk of disease recurrence and development of a second cancer of the UADT. CONCLUSIONS Patients with early-stage oropharynx cancer have high rates of disease control when treated with radiation. Lymphatic and hematogenous metastases are uncommon. Surgical salvage of disease recurrence is successful in approximately one-third of patients. As the majority of recurrences occur within the first 2 years from treatment, close observation during this time period is important. The development of second primary tumors of the UADT adversely impacts survival in these patients to as great a degree as the index cancer.
Collapse
Affiliation(s)
- Ugur Selek
- Department of Radiation Oncology, The University of Texas, M. D. Anderson Cancer Center, Houston, 77030, USA
| | | | | | | | | | | |
Collapse
|