IJOHNS  Vol.2 No.6 , November 2013
Does Surgery Have a Relevant Role in the Primary Treatment of Locoregionally Advanced Oropharyngeal Carcinomas?
ABSTRACT

Background: Treatment concepts for oropharyngeal squamous cell carcinomas are controversial. This review compares the results obtained by distinct treatment options in locoregionally oropharyngeal advanced carcinomas: primary surgical resection followed by concurrent chemoradiotherapy and concurrent chemoradiotherapy alone. Methods: 57 patients with stage III and IV oropharyngeal squamous cell carcinoma were selected. 17 patients were treated with primary surgical resection followed by concurrent chemoradiotherapy and 40 patients were treated only with concurrent chemoradiotherapy. Statistical analysis was performed regarding survival rates according to tumor location, stage, treatment regimen and recurrence. Results: Two-year loco-regional control rates were 94% after surgery plus chemoradiotherapy and 55% after chemoradiotherapy (p = 0.016). Progression free survival rates were 88% and 27%, respectively (p < 0.001). Overall survival rates were 88% and 45%, respectively (p = 0.002). Conclusions: In this study, primary surgical resection followed by concurrent chemoradiotherapy showed better clinical outcomes with a lower risk of death associated with tumor and tumor progression.


Cite this paper
J. Guimarães, S. Cruz, E. Breda and E. Monteiro, "Does Surgery Have a Relevant Role in the Primary Treatment of Locoregionally Advanced Oropharyngeal Carcinomas?," International Journal of Otolaryngology and Head & Neck Surgery, Vol. 2 No. 6, 2013, pp. 263-270. doi: 10.4236/ijohns.2013.26055.
References
[1]   P. J. Bradley, “Management of Squamous Cell Carcinoma of the Oropharynx,” Current Opinion in Otolaryngology and Head and Neck Surgery, Vol. 8, No. 2, 2000, pp. 80-86.
http://dx.doi.org/10.1097/00020840-200004000-00002

[2]   M. L. Gillison, “Current Topics in the Epidemiology of Oral Cavity and Oropharyngeal Cancers,” Head and Neck, Vol. 29, No. 8, 2007, pp. 779-792.
http://dx.doi.org/10.1002/hed.20573

[3]   Registo Oncológico Regional do Norte (RORENO).
http://www.ipoporto.pt/sobre/universo-ipo-porto/

[4]   A. K. Chaturvedi, E. A. Engels, W. F. Anderson and M. L. Gillison, “Incidence Trends for Human Papillomavirus-Related and Unrelated Oral Squamous Cell Carcinomas in the United States,” Journal of Clinical Oncology, Vol. 26, No. 4, 2008, pp. 612-619.
http://dx.doi.org/10.1200/JCO.2007.14.1713

[5]   J. C. Wadsley and S. M. Bentzen, “Investigation of Relationship between Change in Locoregional Control and Change in Overall Survival in Randomized Controlled Trials of Modified Radiotherapy in Head-and-Neck Cancer,” International Journal of Radiation Oncology*Biology *Physics, Vol. 60, No. 5, 2004, pp. 1405-1409.

[6]   R. E. Lundahl, R. L. Foote, J. A. Bonner, V. J. Suman, J. E. Lewis, et al., “Combined Neck Dissection and postoperative Radiation Therapy in the Management of the High-Risk Neck: A Matched-Pair Analysis,” International Journal of Radiation Oncology*Biology*Physics, Vol. 40, No. 3, 1998, pp. 529-534.

[7]   U. Duvvuri and J. N. Myers, “Contemporary Management of Oropharyngeal Cancer: Anatomy and Physiology of the Oropharynx,” Current Problems in Surgery, Vol. 46, No. 2, 2009, pp. 119-184.
http://dx.doi.org/10.1067/j.cpsurg.2008.10.003

[8]   J. M. Bumpous, “Surgical Salvage of Cancer of the Oropharynx after Chemoradiation,” Current Oncology Reports, Vol. 11, No. 2, 2009, pp. 151-155.
http://dx.doi.org/10.1007/s11912-009-0022-6

[9]   J. T. Parsons, W. M. Mendenhall, S. P. Stringer, R. J. Amdur, R. W. Hinerman, et al., “Squamous Cell Carcinoma of the Oropharynx Surgery, Radiation Therapy, or Both,” Cancer, Vol. 26, No. 11, 2002, pp. 612-619.

[10]   D. A. Fein, W. R. Lee, W. R. Amos, R. W. Hinerman, J. T. Parsons, et al., “Oropharyngeal Carcinoma Treated with Radiotherapy: A 30-Year Experience,” International Journal of Radiation Oncology*Biology*Physics, Vol. 34, No. 2, 1996, pp. 289-296.

[11]   J. P. Bataini, B. Asselain, C. Jaulerry, F. Burnin, J. Bernier, et al., “A Multivariate Primary Tumour Control Analysis in 465 Patients Treated by Radical Radiotherapy for Cancer of the Tonsillar Region: Clinical and Treatment Parameters as Prognostic Factors,” Radiotherapy & Oncology, Vol. 14, No. 4, 1989, pp. 265-277.
http://dx.doi.org/10.1016/0167-8140(89)90138-2

[12]   G. Calais, M. Alfonsi, E. Bardet, C. Sire, T. Germain, et al., “Randomized Trial of Radiation Therapy versus Concomitante Chemotherapy and Radiation Therapy for Advanced-Stage Oropharyngeal Carcinoma,” Journal of the National Cancer Institute, Vol. 91, No. 24, 1999, pp. 2081-2086. http://dx.doi.org/10.1093/jnci/91.24.2081

[13]   D. J. Adelstein, P. Lavertu, J. P. Saxton, M. Secic, B. J. Wood, et al., “Mature Results of a Phase III Randomized trial Comparing Concurrent Chemoradiotherapy with Radiation Therapy Alone in Patients with Stage III and IV Squamous Cell Carcinoma of the Head and Neck,” Cancer, Vol. 88, No. 4, 2000, pp. 876-883.
http://dx.doi.org/10.1002/(SICI)1097-0142(20000215)88:4<876::AID-CNCR19>3.0.CO;2-Y

[14]   K. C. Soo, E. H. Tan, J. Wee, B. Lim, D. C. Tai, et al., “Surgery and Adjuvant Radiotherapy vs. Concurrent Chemoradiotherapy in Stage III/IV Nonmetastatic Squamous Cell Head and Neck Cancer: A Randomized Comparison,” British Journal of Cancer, Vol. 93, No. 3, 2005, pp. 279-286. http://dx.doi.org/10.1038/sj.bjc.6602696

[15]   P. Boscolo-Rizzo, A. Gava, V. Baggio, C. Marchiori, M. Stellin, et al., “Matched Survival Analysis in Patients with Locoregionally Advanced Resectable Oropharyngeal Carcinoma: Platinum-Based Induction and Concurrent Chemoradiotherapy versus Primary Surgical Resection,” International Journal of Radiation Oncology*Biology* Physics, Vol. 80, No. 1, 2011, pp. 154-160.

[16]   J. L. Lefebvre, D. Chevalier, B. Luboinski, A. Kirkpatrick, L. Collette and T. Sahmoud, and for the EORTC Head and Neck Cancer Cooperative Group, “Larynx Preservation in Pyriform Sinus Cancer: Preliminary Results of a European Organization for Research and Treatment of Cancer Phase III Trial,” Journal of the National Cancer Institute, Vol. 88, No. 13, 1996, pp. 890-899.
http://dx.doi.org/10.1093/jnci/88.13.890

[17]   A. Argiris, B. E. Brockstein, D. J. Haraf , K. M. Stenson, B. B. Mittal, et al., “Competing Causes of Death and Second Primary Tumors in Patients with Locoregionally Advanced Head and Neck Cancer Treated with Chemoradiotherapy,” Clinical Cancer Research, Vol. 10, No. 6, 2004, pp. 1956-1962.
http://dx.doi.org/10.1158/1078-0432.CCR-03-1077

[18]   C. Fakhry, W. H. Westra, S. Li, A. Cmelak, J. A. Ridge, et al., “Improved Survival of Patients with Human Papillomavirus-Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial,” Journal of the National Cancer Institute, Vol. 100, No. 4, 2008, pp. 261-269. http://dx.doi.org/10.1093/jnci/djn011

[19]   A. A. Forastiere, “Chemotherapy in the Treatment of Locally Advanced Head and Neck Cancer,” Journal of Surgical Oncology, Vol. 97, No. 8, 2008, pp. 701-707.
http://dx.doi.org/10.1002/jso.21012

 
 
Top