Source: Doctor’s Guide (www.docguide.com)
Author: Arushi Sinha

Primary surgical treatment does not appear to provide benefits to patients with stage I or II oropharyngeal squamous cell carcinoma, whereas in patients with occult metastases, these procedures offer the opportunity for upstaging and intensification of therapy, according to research presented here at the American Head and Neck Society 7th International Conference on Head and Neck Cancer (AHNS).

Disease staging helps to determine treatment plans and prognosis in patients with oropharyngeal squamous cell carcinoma, so accuracy in staging has definite clinical implications, the researchers noted during their presentation on July 22.

To assess the accuracy of staging information, they reviewed the records of 49 patients with oropharyngeal squamous cell carcinomas, including primary carcinomas of the tonsil (53%), base of tongue (33%), or posterior pharyngeal wall (14%). “When we went back to our results on surgical staging and actually looked at the pathology, some of the tumors were upstaged and some were downstaged,” explained Rohan Walvekar, MD, Department of Otolaryngology — Head and Neck Surgery, Louisiana State University Health Sciences Center New Orleans Louisiana Dr. Walvekar conducted the study while he was at the University of Pittsburgh

Clinical staging data showed that 61% of patients were either stage I or II, and 39% were stage III. With reference to nodal involvement, 58% were N0 and 42% were N1.

As part of the initial workup, neck dissections were performed in 46 of the 49 patients. When compared with clinical staging, neck dissection altered nodal status in 23% of patients and T stage changed in 26% of patients. Combined, neck dissection changed the diagnosis in 40% of patients.

Thirty-five patients received a median follow-up of 8 years, during which 28% of stage I patients and 15% of stage II patients received radiation therapy but no chemotherapy. Among stage III patients, 33% underwent surgery, 47% received additional radiation, and 20% received chemoradiotherapy.

Based on additional findings for staging, chemotherapy was eliminated for 80% of stage III patients. These factors did not influence disease-free survival in 85% or overall survival in 83%.

Based on these results, the authors concluded that a clearer picture at the time of staging can influence the treatment plan, particularly for patients with stage I or II disease.

“With better visualization, we are able to remove these tumors more effectively,” said Dr. Walvekar. “Younger patients are coming to us, and since we know that these cancers have a 15% to 20% recurrence rate, it becomes important to leave the radiotherapy options available.”

[Presentation title: Role of Surgery in Limited (T1-2, N0-1) Cancers of the Oropharyngeal. Abstract P637]