Hon-Yi Lin a, b, Yee-Min Jen b, Dai-Wei Liu c, Jing-Min Hwang d, Moon-Sing Lee a, Shih-Kai Hung a, Hsing-Lung Chao b, Chun-Shu Lin b, Weng-Yoon Shum e
aDepartment of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
bDepartment of Radiation Oncology, Tri-Service General Hospital, Taipei, Taiwan
cDepartment of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
dDepartment of Radiation Oncology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
eDepartment of Radiation Oncology, Jen-Ai Hospital, Taichung, Taiwan
Abstract
Objective
This study intends to define the role of primary surgery for patients with resectable stage III/IV tonsillar carcinoma.
Materials and Methods
From 1987 to 2004, 82 patients with resectable stage III/IV tonsillar carcinoma were treated curatively with surgery plus radiotherapy (n = 22), concurrent chemoradiotherapy (n = 25), or radiotherapy alone (n = 35). We compared surgery plus radiotherapy with concurrent chemoradiotherapy and radiotherapy alone. The primary endpoint was 5-year overall survival.
Results
The median follow-up time was 39 months (range, 1–216 months). All living patients were followed-up for at least 2 years. The 5-year overall survival for surgery plus radiotherapy was similar to that of concurrent chemoradiotherapy (52.9% vs. 58.9%; hazard ratio [HR], 1.46; 95% confidence interval [CI], 0.71–3.01; p = 0.31) and radiotherapy alone (52.9% vs. 45.7%; HR, 0.87; 95% CI, 0.47–1.62; p = 0.66). For 5-year local control, surgery plus radiotherapy was better than radiotherapy alone (68.1% vs. 42.8%; HR, 0.39; 95% CI, 0.16–0.98; p = 0.045). T4 disease resulted in poorer local control than T1–3 disease (HR, 5.89; 95% CI, 2.36–14.70; p < 0.0001). After multivariate analysis, treatment modality had a consistent statistically insignificant impact on all clinical outcomes of interest.
Conclusion
For patients with resectable stage III/IV tonsillar carcinoma, surgery plus radiotherapy is comparable to concurrent chemoradiotherapy and results in better local control than radiotherapy alone. Current evidence is still insufficient to definitively recommend replacing primary surgery with nonsurgical treatment modalities. [Tzu Chi Med J 2008;20(1):49–57]
Keywords
Concurrent chemoradiotherapy (CCRT); Organ preservation Radiotherapy (RT); Surgery plus radiotherapy; Tonsillar carcinoma
