Surgical versus non-surgical management of early stage oropharyngeal squamous cell carcinoma

Abstract

National guidelines state that early-stage oropharyngeal carcinoma can be treated by either primary surgery or radiotherapy. There is a paucity of evidence comparing surgery versus non-surgical therapy within the same population. With the shift in head and neck cancer treatment towards primary chemoradiation, the aim of this observational cohort study was to help define whether surgery still has a role for early-stage oropharyngeal disease, using a national prospective audit of all new head and neck cancers recruited between 1999 and 2001 in Scotland. Patients with T1-2 N0 M0 tumours were identified. Patients were divided into those treated surgically (±adjuvant radiotherapy) or non-surgically. Five-year outcome data were calculated. Forty-two patients were treated surgically (13 received adjuvant radiotherapy) and 32 patients treated non-surgically. Disease-specific 5-year survival was 69 and 60%, respectively (p = 0.22). Locoregional failure occurred in seven of the surgical group and five of the non-surgical group. The success of chemoradiotherapy and the evidence for its use as adjuvant therapy may dissuade clinicians from considering surgical intervention. This study demonstrates the outcomes of surgical and non-surgical therapy within the same population. Where clear margins can be achieved, and in the absence of negative prognostic neck pathology, surgery remains a good option; allowing radiotherapy to be preserved for locoregional failures or second primary tumours. Although there are limitations to this study, it does demonstrate the benefit of prospective population data collection.