title: Can concurrent chemoradiotherapy replace surgery and postoperative radiation for locally advanced stage III/IV tonsillar squamous cell carcinoma?
abstract: OBJECTIVE
  To compare surgery and postoperative radiotherapy (PORT) with the non-surgical combination of chemotherapy and radiation therapy (CCRT) for locally advanced squamous cell carcinoma (SCC) of the tonsil by measuring treatment outcomes and treatment-related complications.
  
  
  METHODS
  The records of 114 patients with non-metastatic stage III/IV tonsillar SCC treated between July, 1998 and December, 2010 were reviewed retrospectively. Among the 114 patients, 65 received PORT and 49 received CCRT. In the PORT group, treatment included wide surgical resection of the tumor with neck dissection and administration of PORT to the primary tumor bed with a median dose of 60 Gy. In the CCRT group, a median dose of 70 Gy was delivered to the gross tumor, and 46 patients received concurrent chemotherapy with i.v. cisplatin. The median follow-up time was 58 months in the PORT group and 44 months in the CCRT group.
  
  
  RESULTS
  There was no significant difference between PORT and CCRT in terms of 5-year locoregional recurrence-free survival (88.4% vs. 91.4%, p=0.68), distant metastasis-free survival (88.9% vs. 92.3%, p=0.60), disease-free survival (79.5% vs. 84.2%, p=0.63) or overall survival (78.9% vs. 88.9%, p=0.45). More CCRT patients than PORT patients experienced grade 3 (or higher) hematological toxicities and grade 2 pharyngitis during treatment. Chronic toxicity, manifested as swallowing difficulty, dry mouth and trismus, was similar between the two treatment groups.
  
  
  CONCLUSIONS
  CCRT provides similar levels of local and distant control in patients with locally advanced tonsillar SCC as PORT, yet fails to show any superiority in preserving functions such as swallowing, saliva production, and mastication.
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
authors.forename: Geumju
authors.initials: G
authors.lastname: Park
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sung-Bae
authors.initials: SB
authors.lastname: Kim
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Dok Hyun
authors.initials: DH
authors.lastname: Yoon
authors.forename: Su Ssan
authors.initials: SS
authors.lastname: Kim
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Yoon
authors.forename: Si Yeol
authors.initials: SY
authors.lastname: Song
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Choi
authors.forename: Seung
authors.initials: S
authors.lastname: DO Ahn
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014067:Tonsillar Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*