The use of intensity-modulated radiation therapy in the treatment of oropharyngeal carcinoma

Surgery and postoperative radiotherapy a valid treatment for advanced oropharyngeal carcinoma

Since 1992 we have prospectively included all head and neck cancer patients in our health region in a departmental based register. Our hospital takes care of all head and neck cancer patients in our health region consisting of approximately 1 million people. In 1997, we evaluated the results of the treatment of oropharyngeal cancer in the 1992–1997 period. On the basis of this evaluation, we changed our treatment policy for tonsillar and base of tongue carcinoma. We first changed the treatment for the lesions with worst prognosis, i.e., those with T3–T4 carcinomas, from radiotherapy only, to radical surgery and postoperative radiotherapy. We have since that time increasingly also operated the smaller oropharyngeal carcinomas. The 2 years’ overall survival and disease-specific survival for all patients diagnosed in the 1992–1997 period was 56 and 63%, respectively. The results from a similar group of patients in the 6 years’ period from 2000 to 2005, after the change in treatment, have increased to 83 and 88%. When we looked at the subgroup of patients in the 2000–2005 period treated with surgery and postoperative radiotherapy, 45 out of 69 patients (65%) presenting with an oropharyngeal cancer were fit for operation. With radical surgery and postoperative radiation therapy, the 2 years overall survival is now 91%. The 2-year disease-specific survival is 96% and the locoregional control is 98%. This is a marked improvement as compared to radiotherapy alone and definitely competitive with modern radiochemotherapy.

Outcomes of primary surgical treatment of T1 and T2 carcinomas of the oropharynx

OBJECTIVES

Oropharyngeal cancers represent 10%-15% of all head and neck cancers. At presentation 60%-70% will have advanced-stage disease with a high incidence of neck metastases. Primary treatment employing radiotherapy, with or without chemotherapy, is widely prescribed. The aim of this study is to analyze the outcome of definitive surgical management of T1-T2 cancers of the oropharynx.

METHODS

We conducted a retrospective cohort study of patients treated at the Sydney Head and Neck Cancer Institute. Patients with previously untreated squamous cell carcinoma (SCC) of the oropharynx were included according to the TNM stage of the disease as follows: T1 or T2, any N-stage, and M0. All patients underwent definitive primary surgical management. Primary analysis endpoints were locoregional control rates and disease-specific survival.

RESULTS

Ninety-two patients were identified, of which 26 were T1 and 66 were T2. Forty-four patients had clinical neck disease, and 57 had postoperative radiotherapy. The results showed no significant difference between the T1 and T2 groups with respect to local control or treatment type; however, advanced-stage neck disease was associated with a worse prognosis. The 5-year disease-specific survival was 83% and local control rate was 87%. Ultimately, 25 of the 92 patients had treatment failure (27%).

CONCLUSIONS

Selected patients with early-stage primary cancers of the oropharynx may be effectively treated with definitive primary surgery.

Partial horizontal laryngectomy and epiglottiplasty

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4% in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7% after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.