Concurrent chemoradiation after surgery extends OS in advanced tonsil cancer

Surgery followed by concurrent chemoradiation produced longer OS in patients with advanced squamous cell carcinoma of the tonsil than other therapies, study data showed.

“The current National Comprehensive Cancer Network guidelines for patients with advanced stage oropharyngeal cancer recommend three different treatment options: definitive concurrent chemoradiation, surgery followed by appropriately selected adjuvant therapy (radiotherapy alone or concurrent chemoradiation depending on pathologic features), or induction chemotherapy followed by radiotherapy or concurrent chemoradiation,” Dylan F. Roden, MD, MPH, resident in the department of otolaryngology-head and neck surgery at New York University, and colleagues wrote. “Although these treatments are believed to have equivalent survival outcomes, to the best of our knowledge, this hypothesis has never been tested in the setting of a randomized clinical trial.”

The researchers used the National Cancer Data Base to review records of 16,891 patients aged 70 years or younger diagnosed with stage III to stage IVb squamous cell carcinoma of the tonsil from 1998 through 2011. All patients received either concurrent chemoradiation alone, surgery plus concurrent chemoradiation or surgery followed by adjuvant radiotherapy.

Concurrent chemoradiation represented the most common therapy (48.1%; n = 8,123), followed by concurrent chemoradiation (31.1%; n = 5,249) and surgery plus radiotherapy (20.8%; n = 3,519).

Patients who underwent surgery followed by concurrent chemoradiation demonstrated the greatest 3-year OS rate (88.5%) compared with those who received surgery and radiotherapy (84%) and those who received concurrent chemoradiation alone (74.2%; P < .0001 for all).

After propensity score matching on a subpopulation of 4,962 patients, surgery plus concurrent chemoradiation still showed the highest OS rate (90.2%), followed by surgery plus radiotherapy (84.9%) and definitive concurrent chemoradiation (82.1%; P < .0001).

“Triple-modality therapy is associated with improved OS compared with definitive concurrent chemoradiation therapy in the treatment of patients with advanced stage cancer of the tonsil,” the researchers wrote. “The assumption that surgical treatment will not add a survival benefit if concurrent chemoradiation therapy is needed might not be true. A prospective clinical trial to escalate treatment, such as those currently underway for patients with HPV­–positive tumors to deescalate treatment, may need to be reconsidered.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures.