Tonsil resection prior to radiation improves survival

Apr 29 2013

By Joanna Lyford, Senior medwireNews Reporter

Performing tonsillectomy before radiotherapy in patients with stage I/II tonsil cancer is associated with improved survival, an analysis of US data indicates.

Michael Holliday (Georgetown University Hospital, Washington, DC) and team used the national Surveillance Epidemiology and End Results Database to examine the impact of surgery on outcomes in patients undergoing definitive radiation therapy for low-stage tonsil carcinoma.

They included 524 patients with stage I and II primary tonsillar squamous cell or epithelial cell tumors. In all, 283 patients underwent surgical resection of the primary tumor prior to undergoing radiotherapy while the remainder underwent only simple biopsy followed by radiotherapy.

Among the patients treated surgically, the most common procedures were local excision/destruction, excisional biopsy, and limited pharyngectomy, while a minority of patients had more extensive procedures such as complete pharyngectomy or mandibulectomy.

For their analysis, Holliday et al compared outcomes in patients treated with surgery followed by radiotherapy with those of patients who received only radiation therapy.

Writing in JAMA Otolaryngology-Head & Neck Surgery, the researchers report that clinical outcomes were better in patients who received both treatment modalities than in those who received only radiation.

Specifically, 5-year overall survival and 5-year disease-specific survival were 83% and 90%, respectively, in patients who received both surgery and radiation versus 64% and 76%, respectively, in patients who received only radiation therapy.

These differences remained statistically significant after adjusting for confounding variables such as patient age and year of diagnosis, say the authors.

The authors note that the optimal management strategy for patients with early-stage tonsil cancer is controversial, admitting that "with the advent of new procedures to address the primary tumor, the debate is far from settled."

Nevertheless, findings from the present study indicate that performing tonsillectomy prior to radiation therapy is associated with better survival outcomes.

"Opportunities for future study would include assessment of local-regional control, surgical selection bias, and the impact of comorbidities in this clinical question," they conclude.

"Ultimately, a prospective, controlled study would be required to determine causation for this particular clinical question."

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