TY - JOUR
T1 - The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region
AU - Laccourreye, O.
AU - Castelnau-Marchand, P.
AU - Rubin, F.
AU - Badoual, C.
AU - Halimi, P.
AU - Giraud, P.
N1 - Publisher Copyright:
© 2017 Elsevier Masson SAS
PY - 2017/9/1
Y1 - 2017/9/1
N2 - To analyze the medical literature devoted to work-up, epidemiology, local control, survival, complications and sequelae after conservative treatment for early-stage squamous cell carcinoma of the tonsillar region. An analysis of the PubMed (1975–2016) database was performed using the following keywords and associations: “tonsil/tonsillar region/oropharynx” AND “squamous cell carcinoma” AND “early-stage (I–II; T1–2N0M0)” AND “radiation therapy/radiotherapy” OR “conservative surgery/oropharyngectomy/transoral surgery/radical tonsillectomy”. The search retrieved 10 retrospective series documenting local control and/or survival in series with more than 50 cases and a minimum 2 years’ follow-up after conservative treatment; no prospective studies, meta-analyses and/or Cochrane analyses were found. Magnetic resonance imaging is the key radiological exam for local extension assessment. Human papilloma virus infection (HPV) is a risk factor that must be screened for systematically, since it induces tumoral radio-sensitivity and increases the risk of specific synchronous and metachronous second primaries. Whatever conservative treatment used, local control and survival rates higher than 85% were achieved. Implementing intensity-modulated radiation therapy reduced the incidence and severity of radiation-related complications and sequelae. Transoral surgery yielded very low morbidity/mortality rates, enabled association to ipsilateral neck dissection, and allowed radiation therapy to be reserved for the management of metachronous second primaries. Transoral surgery appeared to be the first-line option in the majority of cases. Lifetime follow-up adapted to HPV status is mandatory. The development of HPV vaccination does not mean that campaigns against smoking and alcohol abuse are of diminished importance.
AB - To analyze the medical literature devoted to work-up, epidemiology, local control, survival, complications and sequelae after conservative treatment for early-stage squamous cell carcinoma of the tonsillar region. An analysis of the PubMed (1975–2016) database was performed using the following keywords and associations: “tonsil/tonsillar region/oropharynx” AND “squamous cell carcinoma” AND “early-stage (I–II; T1–2N0M0)” AND “radiation therapy/radiotherapy” OR “conservative surgery/oropharyngectomy/transoral surgery/radical tonsillectomy”. The search retrieved 10 retrospective series documenting local control and/or survival in series with more than 50 cases and a minimum 2 years’ follow-up after conservative treatment; no prospective studies, meta-analyses and/or Cochrane analyses were found. Magnetic resonance imaging is the key radiological exam for local extension assessment. Human papilloma virus infection (HPV) is a risk factor that must be screened for systematically, since it induces tumoral radio-sensitivity and increases the risk of specific synchronous and metachronous second primaries. Whatever conservative treatment used, local control and survival rates higher than 85% were achieved. Implementing intensity-modulated radiation therapy reduced the incidence and severity of radiation-related complications and sequelae. Transoral surgery yielded very low morbidity/mortality rates, enabled association to ipsilateral neck dissection, and allowed radiation therapy to be reserved for the management of metachronous second primaries. Transoral surgery appeared to be the first-line option in the majority of cases. Lifetime follow-up adapted to HPV status is mandatory. The development of HPV vaccination does not mean that campaigns against smoking and alcohol abuse are of diminished importance.
KW - Early-stage
KW - Oropharynx
KW - Radiation therapy
KW - Squamous cell carcinoma
KW - Tonsil
KW - Transoral surgery
UR - http://www.scopus.com/inward/record.url?scp=85017454179&partnerID=8YFLogxK
U2 - 10.1016/j.anorl.2017.03.007
DO - 10.1016/j.anorl.2017.03.007
M3 - Short survey
C2 - 28416263
AN - SCOPUS:85017454179
SN - 1879-7296
VL - 134
SP - 259
EP - 264
JO - European Annals of Otorhinolaryngology, Head and Neck Diseases
JF - European Annals of Otorhinolaryngology, Head and Neck Diseases
IS - 4
ER -