Outcomes of primary surgical treatment of T1 and T2 carcinomas of the oropharynx

Abstract

Objectives: Oropharyngeal cancers represent 10%-15% of all head and neck cancers. At presentation 60%-70% will have advanced-stage disease with a high incidence of neck metastases. Primary treatment employing radiotherapy, with or without chemotherapy, is widely prescribed. The aim of this study is to analyze the outcome of definitive surgical management of T1-T2 cancers of the oropharynx.

Methods: We conducted a retrospective cohort study of patients treated at the Sydney Head and Neck Cancer Institute. Patients with previously untreated squamous cell carcinoma (SCC) of the oropharynx were included according to the TNM stage of the disease as follows: T1 or T2, any N-stage, and M0. All patients underwent definitive primary surgical management. Primary analysis endpoints were locoregional control rates and disease-specific survival.

Results: Ninety-two patients were identified, of which 26 were T1 and 66 were T2. Forty-four patients had clinical neck disease, and 57 had postoperative radiotherapy. The results showed no significant difference between the T1 and T2 groups with respect to local control or treatment type; however, advanced-stage neck disease was associated with a worse prognosis. The 5-year disease-specific survival was 83% and local control rate was 87%. Ultimately, 25 of the 92 patients had treatment failure (27%).

Conclusions: Selected patients with early-stage primary cancers of the oropharynx may be effectively treated with definitive primary surgery.