Therapeutic options in patients with early T stage and advanced N stage of tonsillar squamous cell carcinomas

Objective To compare the therapeutic role of surgery followed by radiotherapy (OPRT) and concurrent chemoradiotherapy (CCRT) in patients with early T (T1/T2) and advanced N (N2/N3) stage tonsillar squamous cell carcinoma. Study Design Historical cohort study. Setting A tertiary hospital. Subjects and Methods The medical records of 42 patients who met the eligible criteria (24 patients were treated by OPRT, 18 patients by CCRT) were reviewed. Results Mean overall survival (OS) and disease-free survival (DFS) were 49.0 months and 43.0 months in OPRT group, respectively, and 39.6 months and 35.0 months in CCRT group, respectively (P = 0.18 for OS, P = 0.29 for DFS between the two groups). There was also no significant difference in survival estimates between OPRT and CCRT group in terms of two-year OS (P = 0.18) and two-year DFS (P = 0.45). In the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, the scores for global health status and symptom scales did not differ between the two groups. However, the OPRT group reported better functional scales and significantly higher scores for cognitive (P = 0.008) and social function (P = 0.03). Among single items, a significantly lower score for insomnia (P = 0.007) was noted in the OPRT group. In EORTC QLQ-H&N35 modules, there were no significantly different scales between the two groups except scores for nutritional supplements, in which the OPRT group presented lower symptom scores (P = 0.02). Conclusion OPRT could be still a viable option for managing selected cases of advanced oropharyngeal cancer because one can expect comparable therapeutic outcome as well as quality of life.