Background & objective: There is a controversy in selecting either radiotherapy plus surgery reserved as salvage (Salvage S) or the planned surgery plus preoperative radiotherapy (Planned R+S) as the treatment modality for the tonsillar squamous cell carcinoma. Among stage III- IV patients, the tumor size and the lymph node metastasis were insufficient as the prognostic predictors. The authors retrospectively reviewed the patients with this disease who were treated in Cancer Hospital of Chinese Academy of Medical Sciences to analyze the indications and prognosis of the two treatments.
Methods: A total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma were reviewed from 1984 to 2000. The patients were divided into Salvage S group (group A, 83 cases) and Planned R+S group (group B, 25 cases). Treatment outcome and the surgery related oral dysfunctions were compared in the two groups. The relationship between the response to radiotherapy and the survival rate was analyzed.
Results: The composite resection that led to oral dysfunction was undertaken for 20 (24.1%) of group A patients and for 22 (88.0%) of group B patients. The 5-year survival rates were 59.3% and 55.4% in group A and group B patients, respectively (P=0.706). The 5-year survival rates were 73.0% and 76.9% in the patients whose lymph nodes and surgical specimen showed obvious response to radiotherapy,respectively.
Conclusion: The two treatment modalities reached similar survivals. However, compared with the planned surgery, 60% of composite resection would be withdrawn if surgery reserved as salvage, being benefit to the oral function. The responses to radiotherapy in the lymph nodes and the surgical specimen were good predictors of prognosis.