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Oncologic Benefit of Tonsillectomyin Stage I and II Tonsil CancerCounselors:Dr. Agus surdawi, Sp. THT-KLDr. Tris Sudyartono, Sp.THT-KLDr. Afif Zjauhari, Sp.THT-KL
JAMA OTOLARYNGOL HEAD NECK SURG/VOL 139 (NO. 4), APR 2013Edited byErmando Satria UtomoLutfi Alfianto
Study designRetospective(tonsil cancer Cases from 1988-2006) 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
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 MeasureHazard ratio 5 year DSS and 5 year OSAnalyse univariate and multivariate:SexT1 vs T21988-2003 vs2004-2006Preradiation tonsillectomy vs biopsy only
ResultsRadiation after tonsillectomy 5 year OS 83% And DSS 90%.Radiation after biopsy 5 year OS 64% and DSS 76%.
ConclusionSEER data suggest that tonsil resection prior to radiation improved survival in low stage tonsil cancer (age and year of treatment controlled)
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.
17 registriesPatient with T1 and T2 tumors and N0 neck disease1988-2004 SEER
Patient registered from 1988-2004 T1 and T2 and N0 Neck disease negative Neck dissections negative
Patient registered after 2006
T1 tumors up to 2 cm in greatest dimensionT2 tumors greater than 2 cm and up to 4 cm in greatest dimensionT1 tumors up to 2 cm in greatest dimensionT2 tumors greater than 2 cm and up to 4 cm in greatest dimension
Surgery grouppatients who underwent diagnostic tonsillectomyor more extensive proceduresControl grouppatients who underwent incisional, needle, oraspiration biopsy of the primary site
Statistical AnalysisLog-rank testUnivariateMultivariate
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%).
Discussion2004-2006vs1988-2003younger 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.
Lack information for margin status and local reccurrenceGoal negative margins, our study positive marginDidnt show patient age
Millier et al SEER database 1998-2006 (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 cancer in the United States and abroad has also been reported by HPV prevalence in the oropharynx.
Nguyen et al
SEER data 1974-2003Excellent prognosis young ageHigher incidence HPV assosiated tumors in younger patients. Young patient may have better overall heatlh status. this study used age as proxy for HPV statusOur study
SEER data 1988-2004 and 2004-2006Excellent prognosis young ageYoung patient may have better overall heatlh status. this study used age as proxy for overall health status
conclusionUse surgery or RT for early stage tonsil cancer still remains controversial.OS and DSS: RT after tonsillectomy better than is RT after biopsy alone.