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Abstract

Objective

To investigate the patterns of care and outcomes of treatment of early stage tonsil cancers, controlling for human papillomavirus (HPV) status.

Study Design

Historical cohort study.

Setting

National Cancer Database (NCDB).

Methods

Review of the NCDB between 2010 and 2017 for all T1-2N0M0 tonsillar squamous cell carcinoma (SCC). Demographics, clinical characteristics, HPV status, treatment regimens, and survival were analyzed.

Results

A total of 4720 patients were identified with early stage SCC of the tonsil. Most were tested for HPV (2759 [58.5%]). Among tested patients, 1758 (63.7%) were positive for HPV and 1001 (36.3%) were negative for HPV. HPV-positive patients had higher 3-year survival compared to HPV-negative patients (93.2% vs 77.8%, P < .001). Among HPV-positive patients, there was no significant difference in survival between treatment cohorts. However, in the HPV-negative cohort, 3-year survival was higher in both bimodality surgical-based settings (tonsillectomy + neck dissection + radiotherapy, 86.0% vs chemoradiotherapy, 69.6%, P = .01) and for all surgical-based treatments when compared to nonsurgical management (84.6% vs 69.3%, P < .001). This difference was maintained in multivariable regression controlling for age, sex, comorbidities, clinical T stage, and treatments. In a subpopulation of HPV-negative patients propensity score matched by all factors significant in multivariable analysis, 3-year survival remained higher in the surgically treated group compared to the nonsurgically treated cohort (84.9% vs 67.1%, P < .001).

Conclusions

Surgical- or radiation-based treatment resulted in similar survival in early stage HPV-positive tonsil cancer. Surgical-based treatments were associated with longer survival in HPV-negative cancers. These findings should be further investigated in a randomized prospective trial.

Keywords

tonsil cancer head and neck squamous cell carcinoma human papillomavirus survival

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References

Cleveland

Junger

Saraiya

Markowitz

Dunne

Epstein

. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: implications for dentistry. J Am Dent Assoc. 2011;142(8):915-924.

Chaturvedi

Engels

Anderson

Gillison

. Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. J Clin Oncol. 2008;26(4):612-619.

Ang

Sturgis

. Human papillomavirus as a marker of the natural history and response to therapy of head and neck squamous cell carcinoma. Semin Radiat Oncol. 2012;22(2):128-142.

Ang

Harris

Wheeler

, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24-35.

Ritchie

Smith

Summersgill

, et al. Human papillomavirus infection as a prognostic factor in carcinomas of the oral cavity and oropharynx. Int J Cancer. 2003;104(3):336-344.

National Comprehensive Cancer Network. NCCN clinical practice guidelines for oncology: head and neck cancers. Version 1.2020. Accessed May 1, 2020. https://www.nccn.org/professional/physician_gls/pdf/head-and-neck.pdf

Singh

Mimikos

Groman

, et al. Combined surgery and radiation improves survival of tonsil squamous cell cancers. Oncotarget. 2017;8(68):112442-112450.

Roden

Schreiber

Givi

. Multimodality treatment of early-stage tonsil cancer. Otolaryngol Head Neck Surg. 2017;157(1):62-68.

Ferris

Flamand

Holsinger

, et al. A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311. Oral Oncol. 2020;110:104797.

10.

Bilimoria

Bentrem

Stewart

Winchester

. Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base. J Clin Oncol. 2009;27(25):4177-4181.

11.

Fritz

Percy

Jack

. International Classification of Diseases for Oncology. 3rd ed. World Health Organization; 2013.

12.

Mahmoud

Sung

Civantos

Thomas

Samuels

. Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus. Head Neck. 2017;40(4):710-721.

13.

Spellman

Sload

Kim

Martin

Calzada

. Staging neck dissection and transoral robotic surgery treatment algorithm in palatine tonsil cancer. Otolaryngol Head Neck Surg. 2018;158(3):479-483.

14.

Persky

Albergotti

Rath

, et al. Positive margins by oropharyngeal subsite in transoral robotic surgery for t1/t2 squamous cell carcinoma. Otolaryngol Head Neck Surg. 2017;158(4):660-666.

15.

Lim

Lee

Lim

J-Y

, et al. Management of contralateral N0 neck in tonsillar squamous cell carcinoma. Laryngoscope. 2005;115(9):1672-1675.

16.

Mosto

MCD

Zanetti

Boscolo-Rizzo

. Pattern of lymph node metastases in squamous cell carcinoma of the tonsil: implication for selective neck dissection. Oral Oncol. 2008;45(3):212-217.

17.

Ferlito

Rinaldo

Silver

, et al. Neck dissection: Then and now. Auris Nasus Larynx. 2006;33(4):365-374.

18.

Ferlito

Rinaldo

Silver

, et al. Elective and therapeutic selective neck dissection. Oral Oncol. 2006;42(1):13-24.

19.

Ryzek

D-F

Mantsopoulos

Künzel

, et al. Clinical study early stage oropharyngeal carcinomas: comparing quality of life for different treatment modalities. BioMed Res Int. 2014;2014:421964.

20.

Tschudi

Stoeckli

Schmid

. Quality of life after different treatment modalities for carcinoma of the oropharynx. Laryngoscope. 2003;113(11):1949-1954.

21.

Nichols

Theurer

Prisman

, et al. Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol. 2019;20(10):1349-1359.

22.

ClinicalTrials.gov. 2016—Identifier NCT02984410, study assessing the “best of” radiotherapy vs the “best of” surgery in patients with oropharyngeal carcinoma. Accessed September 15, 2020. https://clinicaltrials.gov/ct2/show/NCT02984410?id=NCT04220749+OR+NCT02984410&draw=2&rank=2&load=cart

23.

ClinicalTrials.gov. 2020—Identifier NCT04220749, radiotherapy vs trans-oral surgery for HPV-negative oropharyngeal squamous cell carcinoma. Accessed September 15, 2020. https://clinicaltrials.gov/ct2/show/NCT04220749?id=NCT04220749&draw=2&rank=1&load=cart

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