title: Treatment selection for tonsillar squamous cell carcinoma.
abstract: BACKGROUND
  The optimal treatment for tonsillar squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to evaluate long-term treatment outcomes of patients with tonsillar SCC, in order to aid in appropriate treatment selection.
  
  
  METHODS
  We conducted a retrospective chart review of 105 patients with curatively treated tonsillar SCC between January 1996 and December 2005. Forty-three patients (41.0%) underwent primary surgery with or without adjuvant therapy (primary surgery group), and 62 patients (59.0%) were treated with radiotherapy/chemoradiotherapy (RT/CRT, organ preservation group). Twenty patients (19%) received tumor tonsillectomy before definitive RT/CRT and were grouped into the organ preservation group.
  
  
  RESULTS
  No significant differences were observed between the primary surgery and organ preservation groups in terms of local control (p = 0.212), regional control (p = 0.684), distant metastasis (p = 0.627), 5-year disease-specific survival (DSS, p = 0.774), and overall survival rates (OS, p = 0.667). The rates of major complication (p = 0.216), long-term dependency on feeding tubes (p = 0.876), and tracheostomy (p = 0.401) were also similar. Advanced T classification (T3-4) was the only factor associated with significantly worse DSS (p = 0.007) and OS (p = 0.012). However, there was also no difference in final treatment outcomes in T3-4 patients regardless of whether they were treated with primary surgery or RT/CRT. In the organ preservation group, tumor tonsillectomy before RT/CRT did not improve local control (p = 0.520) or other treatment outcomes, including 5-year DSS (p = 0.707) and OS (p = 0.745).
  
  
  CONCLUSIONS
  Both primary surgery and RT/CRT organ preservation are effective treatments for tonsillar SCC. Single modality treatment, either surgery or RT/CRT, can typically be provided for stage I-II diseases. Although RT/CRT organ preservation is used more frequently for stage III-IV tonsillar SCC in recent years, primary surgery combined with adjuvant therapy still achieves equivalent outcomes. Multidisciplinary pretreatment counseling and the facilities and personnel available are therefore important for decision-making. In addition, if RT/CRT organ preservation is selected as the primary treatment, tumor tonsillectomy is not indicated.
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yao-Yuan
authors.initials: YY
authors.lastname: Kuo
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Chang
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Wang
authors.forename: Tung-Lung
authors.initials: TL
authors.lastname: Tsai
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
authors.forename: Ling-Wei
authors.initials: LW
authors.lastname: Wang
authors.forename: Shyh-Kuan
authors.initials: SK
authors.lastname: Tai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D014067:Tonsillar Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D014068:Tonsillectomy