Abstract
The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13 % presented with stage I and II (UICC/AJCC 2002) tumors and 87 % with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95 %) and with (66 %) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan–Meier local and loco-regional control was 78 % for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan–Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59 % for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.
Highlights
Squamous cell carcinoma (SCC) of the tonsil is one of the most common types of cancer in the oropharynx worldwide
Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13 % presented with stage I and II (UICC/American Joint Committee on Cancer (AJCC) 2002) tumors and 87 % with stages III and IVa
Adjuvantradiotherapy was mainly performed in cases of advanced neck disease (N2a/b/c) or when the histopathological examination revealed extracapsular spread and/or lymphatic micrometastases
Summary
Squamous cell carcinoma (SCC) of the tonsil is one of the most common types of cancer in the oropharynx worldwide. Where the incidence reaches 20 %, tonsillar carcinoma is the most significant subgroup of oropharyngeal cancer [2]. Incidence of oropharyngeal cancer strongly correlates to the consumption of alcohol and tobacco [3]. The incidence of carcinoma of the tonsil has significantly increased over the last 10 years, in a younger age group, as a consequence of human papilloma virus (HPV) [4]. The available treatment options for tonsillar cancer are open surgery, endoscopic transoral surgical approaches and non-surgical procedures. Depending on the tumor size and the defect following tumor resection, open surgical procedures can range from a simple resection with primary closure to local or regional flaps and to microvascular
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