title: Minimal benefit of tonsillectomy in T1-T2 tonsillar squamous cell carcinoma treated with chemoradiotherapy.
abstract: BACKGROUND
  Chemoradiotherapy (CRT) has become the mainstay of treatment for tonsillar squamous cell carcinoma (SCC). Pre-CRT tonsillectomy is frequently performed, mostly for small primary tumors (T1-T2). However, the benefits of pre-CRT tonsillectomy remain unclear.
  
  
  METHODS
  A retrospective review was performed in 66 patients with T1-T2 tonsillar SCCs treated by CRT from 1997 to 2009. The efficacy of pre-CRT tonsillectomy was analyzed with regard to oncological and functional outcomes.
  
  
  RESULTS
  Thirty patients (45.5%) received tonsillectomy (pre-CRT tonsillectomy group), and 36 patients (54.5%) did not (CRT group). Except for a trend toward more T1 cases (33.3% vs. 13.9%, p = 0.061) and significantly less chemotherapy use (60% vs. 86.1%, p = 0.016) in the pre-CRT tonsillectomy group, there were no differences between the two groups in terms of age, gender, N classification (nodal status), overall stage, radiation dose, duration, or technique. In the pre-CRT tonsillectomy group, eight cases (26.7%) achieved an adequate operative margin judged by the surgeon, and only one (12.5%) had a negative pathological margin. In long-term follow-up, there were no statistically significant differences between the two groups regarding local (93.3% vs. 91.7%, p = 0.82) or regional control (93.3% vs. 94.4%, p = 0.84). The pre-CRT tonsillectomy group did not have a better 5-year disease-specific survival rate (83.3% vs. 94.4%, p = 0.177) or 5-year overall survival rate (70% vs. 94.4%, p = 0.017). There were no differences in complications or functional results (feeding tube and tracheostomy dependence), and quality of life demonstrated no significant difference.
  
  
  CONCLUSIONS
  Pre-CRT tonsillectomy contributes little to oncological and functional outcomes in patients with T1-T2 tonsillar SCC.
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yun-Ting
authors.initials: YT
authors.lastname: Chao
authors.affiliation: Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ling-Wei
authors.initials: LW
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.affiliation: Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Yen-Bin
authors.initials: YB
authors.lastname: Hsu
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Tsung-Lun
authors.initials: TL
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan, ROC; Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: sktai.tw@gmail.com.
authors.forename: Shyh-Kuan
authors.initials: SK
authors.lastname: Tai
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D059248:Chemoradiotherapy; 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
keywords: chemoradiotherapy; quality of life; surgical margin; tonsillar squamous cell carcinoma; tonsillectomy