Role of primary surgery for early-stage (T1-2N0) squamous cell carcinoma of the oropharynx

Abstract

To evaluate treatment outcomes and the role of primary definitive surgery for T(1-2), clinically N(0) oropharyngeal squamous cell carcinoma (OPSCC) patients, we performed a retrospective analysis of 46 consecutive cases treated primarily by surgery and/or postoperative radiotherapy at Yonsei University between May 1992 and December 2006. Twelve patients were T(1) and 34 were T(2). The most common location was the tonsil (54%), followed by the soft palate (19%), the base of the tongue (BOT) (15%) and the posterior wall (12%). Occult lymph node metastasis was noted in 12 cases (26%). Seventeen patients (37%) received adjuvant radiotherapy. The 5-year disease-specific survival rate (DSSR) was 83%: 100% for clinical stage I (T(1)N(0)) and 74% for clinical stage II (T(2)N(0)). The 5-year DSSR of patients with surgery alone was 86%. Thirteen of 14 patients (93%) treated with conservative surgery alone without mandible-splitting or adjuvant radiotherapy attained disease-free status. In addition, 25 of 40 patients (63%) with disease-free status were treated with surgery alone. Almost 30% of all patients may be candidates for adjuvant chemotherapy through histopathologic analysis according to the National Comprehensive Cancer Network (2007) guidelines. The results of the present study demonstrate excellent oncologic outcomes with primary surgery for the treatment of early-stage OPSCC and suggest that surgery offers the best opportunity to identify patients in whom adjuvant radio- or chemotherapy may be most appropriately applied