Management of tonsillar squamous cell carcinoma

Area of Science:

• Oncology
• Head and Neck Surgery
• Radiation Oncology

Background:

• Tonsillar squamous cell carcinoma (TSCC) is a significant head and neck malignancy.
• Treatment decisions for TSCC involve balancing oncologic outcomes with functional preservation.
• Surgical and radiotherapy approaches have evolved for managing TSCC.

Purpose of the Study:

• To compare the outcomes of two treatment strategies for tonsillar squamous cell carcinoma.
• To evaluate the efficacy and functional impact of salvage surgery versus planned surgery in TSCC treatment.
• To determine the optimal primary treatment modality for TSCC.

Main Methods:

• Retrospective review of 108 patients with biopsy-proven TSCC treated between 1984 and 2000.
• Comparison of two treatment arms: Salvage Surgery (radiotherapy followed by surgery if needed) and Planned Surgery (preoperative radiation followed by surgery).
• Analysis of radical surgery rates, local and neck recurrence rates, and 5-year survival.

Main Results:

• Planned Surgery utilized radical surgery in 88.0% of cases, compared to 24.1% in Salvage Surgery (P=0.000).
• Local recurrence rates were 20.0% for Planned Surgery and 28.9% for Salvage Surgery (P=0.378).
• Five-year survival rates were comparable: 55.3% for Planned Surgery and 59.3% for Salvage Surgery (P=0.7056).

Conclusions:

• Salvage Surgery allowed avoidance of extensive 'commando' operations in 60% of cases, improving oral function recovery.
• While survival rates are similar, the less invasive nature of Salvage Surgery is advantageous.
• Primary radiotherapy is recommended for TSCC, with salvage surgery reserved for persistent or recurrent disease.