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- Title
Presurgical induction chemotherapy for squamous cell carcinoma of the tonsil.
- Authors
Burke, Mark S.; Loree, John T.; Popat, Saurin R.; Ford, Daniel; Kim, Jae; Szymanowski, Adam R.; Loree, Thom R.
- Abstract
<bold>Objectives/hypothesis: </bold>The indications for and efficacy of induction chemotherapy in the management of squamous cell carcinoma of the head and neck is controversial. With the advent of human papillomavirus (HPV)-related cancers, survival has improved significantly. Here we present a group of patients with tonsil cancer treated with induction chemotherapy followed by surgery.<bold>Study Design: </bold>Retrospective cohort study.<bold>Methods: </bold>Thirty-eight patients with tonsil cancer were treated with induction chemotherapy, consisting of cisplatin and docetaxel, followed by neck dissection and radical tonsillectomy. Twenty-six patients were HPV+, 28 were nonsmokers or long-term former smokers, and 28 were T1/T2. Fourteen patients required postoperative chemoradiotherapy (CRT). Median follow-up time was 4.1 years.<bold>Results: </bold>A complete response to induction chemotherapy was achieved in 45% (17) of patients. In total, 76% (29/38) of patients were successfully treated: 53% (20/38) with chemotherapy and surgery alone, and 24% (9/38) required postoperative CRT. Almost 90% (23/26) of HPV+ and half (6/12) of HPV- patients are no evidence of disease (NED). HPV status is a significant prognostic factor (P = .02). Only 38% (5/13) of current smokers were NED compared to 96% (24/25) of nonsmokers (P = .0002). All HPV+ nonsmokers (20/20) were NED at last follow-up.<bold>Conclusions: </bold>In this study, the primary driver of prognosis was smoking status. HPV status and T stage were also important. The prognosis for HPV+ nonsmokers is extremely good; most likely regardless of treatment. Treatment failures have a poor chance of salvage, irrespective of treatment type. With the major exception of HPV- smokers, induction chemotherapy followed by surgery with selective CRT is a viable treatment option for tonsil cancer.<bold>Level Of Evidence: </bold>4 Laryngoscope, 130:1206-1211, 2020.
- Subjects
SQUAMOUS cell carcinoma; NECK dissection; CHEMORADIOTHERAPY; CANCER chemotherapy; TONSILS; EX-smokers; THERAPEUTIC use of antineoplastic agents; NECK surgery; PREOPERATIVE period; RETROSPECTIVE studies; CISPLATIN; PAPILLOMAVIRUS diseases; PHARYNX tumors; LONGITUDINAL method
- Publication
Laryngoscope, 2020, Vol 130, Issue 5, p1206
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.28180