PROGNOSTIC FACTORS OF LATERAL WALL OROPHARYNGEAL SQUAMOUS CELL CARCINOMA TOMOHIKO NIGAURI, M.D., SHIN ETSU KAMATA, M.D., KAZUYOSHI KAWABATA, M.D. MUNE
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1 PROGNOSTIC FACTORS OF LATERAL WALL OROPHARYNGEAL SQUAMOUS CELL CARCINOMA TOMOHIKO NIGAURI, M.D., SHIN ETSU KAMATA, M.D., KAZUYOSHI KAWABATA, M.D. MUNENAGA NAKAMIZO, M.D., KATSUFUMI HOKI, M.D., HIROKI MITANI, M.D. TATSUMI NAGAHASHI, M.D., KAZUHIKO YOKOSHIMA, M.D., and SEIICHI YOSHIMOTO, M.D. Department of Head and Neck, Cancer Instiute Hospital, Tokyo We reviewed 79 patients with squamous cell carcinoma of the lateral wall of the oropharynx who received treatment at the Cancer Institute Hospital, Tokyo. between 1971 and There were 67 men and 12 women, aged 31 to 81 years (average 59.2 years). The tumors could be staged by TNM classification (UICC 1987) as follows: Stage I 0, Stage II 12, Stage III 27, Stage IV 40. It must be noted that more than 50% of the tumors were classified as stage IV. As the initial treatment, 50 patients underwent radical radiotherapy, and the remaining 29 were treated mainly by surgery after pre-operative radiation. Some patients underwent adjuvant chemotherapy, but the role of chemotherapy was not considered in this study. The purpose of the present study was to derermine the prognostic factors and to determine the survival rate after each treatment modality. The results were as follows: i) Patients with either T4, over N2b or a stage IV tumor had a significantly poor prognosis. ii) Cox multivariate analysis revealed that age, local extension (base of tongue, anterior pillar, soft palate and mid-line), pathological findings (poorly, moderately or well differentiated), tumor type (exophytic or endophytic) were not useful prognostic factors. iii) Radiosensitivity was not reflected in the survival rate judging from the high recurrence rate (44%) after radical radiotherapy. On the other hand, local recurrence after radical resection was seen in 18% of the patients. iv) Analysis of the data supported the recommendation of surgery after preoperative radiation as the treatment for stage III patients. It seems difficult to find the best treatment modality for stage IV patients in order to improve the survival rate, and this is an issue that still remains to be resolved. v) From the study of the surgical specimens, we are unable to demonstrate a significant survival advantage of the patients with a high grade radiation effect, or patients with no vessel involvement.
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9 6) Remmler D, Medina JE, Byers RM, Meoz R, Pfalzgraf K: Treatment of choice for squamous carcinoma of the tonsillar fossa. Head Neck 7: 206 gery reserved for radiation failure. Laryngoscope 27: , ) Maltz R, Shumrick DA, Aron BS, Waichert KA: apy. Laryngoscope 84: , , ) Kaplan R, Million RR, Cassisi NJ: Carcinoma of
10 sis of factors in the successful management of cancer of tonsillar region. Cancer 41: , ) Zhang ZH, Hu YH, Xu GZ. Gu XZ: Radiation 19) Shukovsky LJ, Fletcher GH: Time-dose and tumor treatment of carcinoma of the oropharynx. Acta volume relationships in squamous cell carcinoma of Radiologica Oncology 22: , the tonsillar fossa. Radiology 107: , ) Gehanno P, Depondt J, Guedon C, Kebailic C, Koka V: Primary and salvage surgery for cancer of the tonsillar region: A retrospective study of 120 patients. Head Neck 15: , ) Lee WR, Mendenhall WM, Parsons JT, Million RR, Cassisi NJ. et at: Carcinoma of the tonsillar region: A multivariate analysis of 243 patients treated with radical radiotherapy. Head Neck 15:
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