T4 Oropharyngeal Squamous Cell Carcinoma: Primary Management Outcomes

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.