Oncologic Benefit of Tonsillectomy

in Stage I and II Tonsil Cancer

JAMA OTOLARYNGOL HEAD NECK
SURG/VOL 139 (NO. 4), APR 2013

Counselors:
Dr. Agus surdawi, Sp. THT-KL
Dr. Tris Sudyartono, Sp.THT-KL
Dr. Afif Zjauhari, Sp.THT-KL
Edited by
Ermando Satria Utomo
Lutfi Alfianto

Abstract

Treatment of low-stage tonsil cancer with

radiotherapy is common, but the type of
diagnostic procedure prior to radiotherapy
varies. This study uses the Surveillance
Epidemiology and End Results (SEER)
registry
to
determine
whether
tonsillectomy or other surgical procedures
prior to radiotherapy have an impact on
outcome
Retospective
(tonsil cancer
Cases from 19882006)

Study
design

Objective
To demonstrate whether tonsillectomy
adds oncologic advantage over biopsy
alone in stage I or II tonsil cancers
prior to definitive radiotherapy

Subjects
Patient with stage I and II
primary tonsil carcinoma who
received
definitive
radiation
treatment

Main Outcomes and

Measure
Hazard ratio 5 year DSS and 5 year OS
Analyse univariate and multivariate:
Sex
T1 vs T2
1988-2003 vs2004-2006
Preradiation tonsillectomy vs biopsy
only

Results
Radiation after tonsillectomy 5 year
OS 83%
And DSS 90%.
Radiation after biopsy 5 year OS 64%
and DSS 76%.

Conclusion
SEER data suggest that tonsil
resection prior to radiation improved
survival in low stage tonsil cancer
(age
and
year
of
treatment
controlled)

Introduction

 Squamous
cell
carcinoma
tonsil most common cancer
of the oropharynx past 30
years.
National
Comprehensive
Cancer
Network
guidelines
recommended RT or surgical
resection
with
or
without
elective neck dissection for low
stage tonsil cancer.

 Radical
tonsillectomy
in
contrast not chose for
diagnostic prosedur cause
diagnostic procedure.

Metods

 17 registries
Patient with T1
and T2 tumors
and
N0
neck
disease
1988-2004

SEER

INCLUDE
EXCLUDE
Patient
registered
from 19882004
T1 and T2
and N0
Neck
disease
negative
Neck
dissections
negative

Patient
registered
after 2006

T1 tumors up to
2 cm in greatest
dimension
T2 tumors
greater than 2 cm
and up to 4 cm in
greatest
dimension

T1 tumors up
to 2 cm in
greatest
dimension
T2 tumors
greater than 2
cm and up to 4
cm in greatest
dimension

Surgery
group
patients who
underwent
diagnostic
tonsillectomy
or more extensive
Control group
procedures
patients who
underwent
incisional,
needle, or
aspiration biopsy
of the primary
site

Statistical
Analysis
Log-rank test
Univariate
Multivariate

Results

 524 patients with T1 and T2 tonsillar

squamous cell or epitel cell tumor.
Subgroup distribution T2 cancers >T1 (322
or 61%)
Non surgical group > surgical group (2.5
times) for Hazard Ratio over 5 years.
Patient register between 1988-2003 >
2004-2006 for Hazard ratio (HR: 2.55 DSS;
HR:2.03 OS).
5 years DSS: surgical>non surgical (90% >
76%).

Discussion
2004-2006vs1988-2003younger
age was also associated with
survival benefit. Each of these
parameters significantly affected OS
and DSS, and significance was
maintained in multivariate analysis.

Yildrim et al (1979-2004)
120 total patient--> 20 had
stage I or II disease.
5 years OS stage I and II
(100% and 77%).
Most patient (83%) had
stage III or IV disease.

Our study
(1988-2004)
524 total
patient
5 years OS
stage I and II
(83.2%).
our study
focused
exclusively on
stage I and II
cancer.

SEER database
Lack information for margin status
and local reccurrence
Goal negative margins, our study
positive margin
Didnt show patient age

Millier et al
SEER database 19982006 (updated)
increase of incidence
tonsil cancer cause
human papilloma virus
(HPV) and how to
effective treatment

Our study
SEER database
1988-2004 and
2004-2006 (longer
frame time)

Increses of incidence tonsil

Increses of incidence tonsil
cancer in the United States
cancer in the United States
and abroad has also been
and abroad has also been
reported by HPV prevalence in
reported by HPV prevalence in
the oropharynx.
the oropharynx.

Nguyen et al
SEER data
1974-2003
Excellent
prognosis young
age
Higher incidence
HPV assosiated
tumors in younger
patients. Young
patient may have
better overall
heatlh status.
this study used
age as proxy for
HPV status

Our study
SEER data
1988-2004 and
2004-2006
Excellent
prognosis young
age
Young patient
may have better
overall heatlh
status.
this study used
age as proxy for
overall health
status

conclusi
on

Use surgery or RT for early

stage tonsil cancer still
remains controversial.
OS and DSS: RT after tonsillectomy
better than is RT after biopsy
alone.