07132020Mon
Last updateFri, 15 May 2020 8am

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

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

aDepartment of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
bSchool of Medicine, Tzu Chi University, Hualien, Taiwan
cDepartment of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
dDepartment of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
eDivision of Hematology-Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
fDepartment of Radiation Oncology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
gDepartment of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

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Abstract

Objective
The aim of this study was to explore the role of nasopharynx (NP) invasion alone in tonsillar carcinoma.
Materials and Methods
From 1987 to 2005, 32 patients with unresect-able cT4b tonsillar carcinoma were retrospectively divided into two groups: the NP-only group, that included 11 patients with NP invasion alone without fitting other T4 criteria; and the other-T4b group, that included the remaining 21 patients. Local control and overall survival were the main endpoints of interest.
Results
At the time of this analysis, 28 patients had died, with a median follow-up time for all 32 patients of 13 months (range, 1-228 months). The mean follow-up period for the four living patients was 180 months (range, 125-228 months). When compared with the other T4b patients, patients with NP invasion alone, without fitting other T4 criteria, had greater 5-year local control (63.6% vs. 14.3%, p = 0.026; hazard ratio for local failure, 0.31; 95% confidence interval, 0.11-0.94) and 5-year overall survival (45.5% vs. 10.3%, p = 0.022; hazard ratio for death from any cause, 0.34; 95% confidence interval, 0.13-0.89).
Conclusion
In patients with tonsillar carcinoma, nasopharynx invasion alone should not be considered as an independent criterion of T4b classification in the next version of cancer staging.


Keywords

Cancer stage; Concurrent chemoradiotherapy; Nasopharynx; Radiotherapy; Tonsillar carcinoma


 

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