T4 Oropharyngeal Squamous Cell Carcinoma: Primary Management Outcomes. (23rd August 2013)

• Record Type: Journal Article
• Authors: Van Abel, Kathryn M.; Moore, Eric J.; Price, Daniel L.; Oldenburg, Michael; Kasperbauer, Jan L.; Olsen, Kerry D.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 149(2013)Supplement 2
• Page Start: P79
• Page End: P80
• Publication Date: 2013-08-23
• Subjects: Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599813495815a138
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract : Objectives: 1) Describe T4a and T4b oropharyngeal squamous cell carcinoma (OPSCC) and its management. 2) Analyze morbidity, functional and oncologic outcomes, and survival associated with four major treatment strategies. Methods: We retrospectively reviewed functional, clinical, and oncologic outcomes for patients diagnosed with T4 OPSCC at a tertiary institution from 1990‐2010. Patients underwent primary 1) surgery + chemoradiation (Group 1), 2) surgery + radiation (Group 2), 3) chemoradiation (Group 3), or 4) chemoradiation + neck dissection (Group 4). Preliminary analysis of ongoing study (N = 120). Results: 47 patients were included (32% female, 68% male; mean age 58.8 years, range 43‐82). Groups 3 and 4 had a higher preoperative nodal stage ( P = 0.02). Complications and PEG placement/dependence were similar across groups. Groups 2 and 4 had higher rates of surgical airway dependence at last follow up ( P =0.05). Average follow up was 43 months (median 26, range 2‐167). Two/five year overall survival was 83%/54% for Group 1, 60%/40% for Group 2, 64%/32% for Group 3, and 80%/30% for Group 4 ( P =0.82). Disease specific survival at two/five/ten years was 83%/63%/31% for Group 1, 70%/58%/44% for Group 2, 68%/60%/48% for Group 3, and 80%/40 %/40% for Group 4 ( P =0.97). Progression free survival at two/five years was 80%/80% for Group 1, 57%/57% for Group 2, 68%/58% for Group 3, and 40%/40% for Group 4. Conclusions: For a disease in which improved survival and oncologic outcomes are measured in months, primary surgery followed by chemoradiation may achieve this goal without sacrificing morbidity or functional outcomes.