Minimal benefit of tonsillectomy in T1-T2 tonsillar squamous cell carcinoma treated with chemoradiotherapy

Chemoradiotherapy (CRT) has become the mainstay of treatment for tonsillar squamous cell carcinoma (SCC). Pre-CRT tonsillectomy is frequently performed, mostly for small primary tumors (T1-T2). However, the benefits of pre-CRT tonsillectomy remain unclear.

A retrospective review was performed in 66 patients with T1-T2 tonsillar SCCs treated by CRT from 1997 to 2009. The efficacy of pre-CRT tonsillectomy was analyzed with regard to oncological and functional outcomes.

Thirty patients (45.5%) received tonsillectomy (pre-CRT tonsillectomy group), and 36 patients (54.5%) did not (CRT group). Except for a trend toward more T1 cases (33.3% vs. 13.9%, p = 0.061) and significantly less chemotherapy use (60% vs. 86.1%, p = 0.016) in the pre-CRT tonsillectomy group, there were no differences between the two groups in terms of age, gender, N classification (nodal status), overall stage, radiation dose, duration, or technique. In the pre-CRT tonsillectomy group, eight cases (26.7%) achieved an adequate operative margin judged by the surgeon, and only one (12.5%) had a negative pathological margin. In long-term follow-up, there were no statistically significant differences between the two groups regarding local (93.3% vs. 91.7%, p = 0.82) or regional control (93.3% vs. 94.4%, p = 0.84). The pre-CRT tonsillectomy group did not have a better 5-year disease-specific survival rate (83.3% vs. 94.4%, p = 0.177) or 5-year overall survival rate (70% vs. 94.4%, p = 0.017). There were no differences in complications or functional results (feeding tube and tracheostomy dependence), and quality of life demonstrated no significant difference.

Pre-CRT tonsillectomy contributes little to oncological and functional outcomes in patients with T1-T2 tonsillar SCC.