Background: Early-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS).
Material/methods: Retrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT.
Results: 61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22-1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24-1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw.
Conclusions: Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.
Keywords: Oropharyngeal cancer; Radiotherapy; Surgery.