Treatment of Oropharyngeal Squamous Cell Carcinoma: A SEER Treatment Review

Abstract

Since most oropharyngeal carcinomas are locally advanced at presentation, patients are often treated with radiation therapy and/or chemotherapy. However, for early stage oropharyngeal carcinoma, national guidelines state that it can be treated by either primary surgery or radiotherapy. This study analyzes national survival rates of oropharyngeal squamous cell carcinoma for surgical and non-surgical treatment modalities. All cases of squamous cell carcinoma of the oropharynx between 1988 and 2007 were selected from the Surveillance, Epidemiology and End Results (SEER) 17 database. The SEER database is a population-based cancer registry that captures 17 distinct population groups in 198 counties in the United States. It represents approximately 26% of the overall United States population and contains information on 6,117,327 cases of cancer diagnosed since 1973. Overall survival was the primary outcome measure. Survival curves were generated using the Kaplan-Meier method and compared using the Mantel-Cox log-rank test. Significance was defined as P < .05. A total of 24,980 patients with squamous cell carcinoma of the oropharynx diagnosed from 1988 to 2007 were analyzed. For Stages I and II post-op RT yielded better survival than pre-op RT (P = 0.0096, hazard ratio = 1.464, 95% CI = 1.097 to 1.954). However, for Stages III and IV there was no difference in survival between the pre-op RT and post-op RT groups (P = .4099; hazard ratio = 0.9518; 95% CI = 0.8464 to 1.070). These data suggest that for early stage oropharyngeal carcinomas, surgery yields better survival rates than radiotherapy alone. Hence, the authors advocate surgery as the first option in these tumors if clear margins can be achieved, allowing radiotherapy to be preserved for locoregional failures or second primary tumors.