Acupuncture Therapy ; Aged ; Female ; Humans ; Radiotherapy ; adverse effects ; Tonsillar Neoplasms ; radiotherapy ; Xerostomia ; etiology ; therapy

Objective: Using propensity score matching method(PSM) to investigate the clinical effect of surgical plus radio(chemo)therapy and non-surgery chemoradiotherapy treatment strategies for advanced tonsillar squamous cell carcinoma. Methods: A retrospective analysis was conducted on the clinical data of 324 patients diagnosed with advanced tonsillar squamous cell carcinoma and treated in Peking Union Medical College Hospital from 2000 to 2018, confirmed by pathology and without distant metastasis. Survival analysis was performed using Kaplan-Meier estimates, the Cox proportional hazards model, and propensity score matching(PSM). Results: Of the 324 patients, 102 were treated with non-surgery chemoradiotherapy treatment strategies and 222 with surgical plus radio(chemo)therapy treatment. Cox multivariate analysis showed that the non-surgery treatment group had a favorable prognosis than the surgical treatment group, however, these outcomes were not significantly different [overall survival(OS): adjusted Hazard Ratios(aHR): 0.92, 95% confidence interval(CI): 0.60-1.42; disease-specific survival(DSS): aHR: 0.71, 95%CI: 0.43-1.20; disease-free survival(DFS): aHR: 0.82, 95%CI: 0.53-1.28]. The new patient cohort consisted of 102 subpairs after PSM. There were no significant differences between two groups(OS: aHR: 0.85, 95%CI: 0.51-1.40; DSS: aHR: 0.62, 95%CI: 0.35-1.11; DFS: aHR: 0.80, 95%CI: 0.49-1.33). Conclusion: Our findings indicate that patients with non-surgical treatment do not have significantly better survival outcomes compared to surgical treatment group, while non-surgical treatment has advantages in improving the quality of life of patients, so comprehensive treatment based on radiotherapy and chemotherapy may be recommended for advanced tonsillar squamous cell carcinoma.
Carcinoma, Squamous Cell/therapy* ; Chemoradiotherapy ; Humans ; Quality of Life ; Retrospective Studies ; Tonsillar Neoplasms/therapy*

PURPOSE: To evaluate the roles of conventional radiotherapy alone or with neoadjuvant chemotherapy for tonsillar carcinomas and any prognostic factors affecting survivals by retrospective analysis. MATERIALS AND METHODS: Thirty four patients received radical radiotherapy for tonsillar carcinomas from Nov. 1985 to Dec. 1993. Of them, 16 patients were treated by conventional radiotherapy alone and the other 18 patients were received radiotherapy with 1 to 3 cycles of neoadjuvant chemotherapy of cisplatin and 5-fluorouracil or pepleomycin. Radiotherapy was performed by 6MV X-ray with daily fraction of 1.8Gy and the range of primary tumor doses was 55.0-86.4Gy(median 66.6Gy), and that of clinically positive nodal doses was 55.8-90Gy(median 69.7Gy). RESULTS: Overall 5-year actuarial survival rate (5YSR) was 32%. The 5YSRs in stage I+II(n=8), III(n=13) and IV(n=13) were 47%, 29% and 25%, respectively(p=0.33). The 5YSRs in T2(n=13), T3(n=10) and T4 (n=7) were 38%, 27% and 0%, respectively and 3 of 4 patients of T1 are alive with NED at 25, 45, 53 months respectively with statistical significance of the trend in survivals among the four T-stages(p=0.01), and those of node negative(n=14) vs node positive patients(n=20) were 31% vs 32%, respectively(p=0.85). There was no significant survival difference between radiotherapy alone group and with neoadjuvant chemotherapy group(22% vs. 38%, p=0.24). The 5YSRs of 21 patients of primary tumor extension to adjacent sites and the other 13 patients of tonsillar proper site were 28% and 38%, respectively but the difference was not significant statistically(p=0.62). There was a statistically significant difference in 5YSRs between the groups of the patients who received radiotherapy in less than 61days vs more than 60days(60% vs. 18%, p=0.027). All living patients without any tumor progression(n=11) had suffered from serious late sequelae such as xerostomia, edentia, dental caries and one patient had the osteoradionecrosis of mandible. On univariate analysis, the duration of radiotherapy and T-stage were the significant prognostic factors affecting 5YSR. On multivariate analysis, also the duration of radiotherapy was the only significant prognostic factor(p=0.01). CONCLUSION: There was no survival difference between the radiotherapy alone and with neoadjuvant chemotherapy groups. Although it was a retrospective study, the role of conventional radiotherapy alone could be effective as the local treatment modality only for the early stage of tonsillar carcinomas. But for the purpose of more improved survivals and better quality of lives of living patients, other altered fractionation such as hyperfractionated radiotherapy with shorter treatment time and smaller fraction size rather than conventional radiotherapy might be beneficial and these prospective studies are needed.
Cisplatin ; Dental Caries ; Drug Therapy ; Fluorouracil ; Humans ; Mandible ; Multivariate Analysis ; Osteoradionecrosis ; Peplomycin ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; Xerostomia

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this study was to evaluate the efficacy of the neoadjuvant chemotherapy and radiotherapy in the treatment of tonsillar neoplasm. MATERIALS AND METHOD: Medical records of 21 patients who received neoadjuvant chemotherapy and radiotherapy for tonsillar neoplasm at Pusan National University Hospital from April 1995 through August 2000 were retrospectively reviewed. RESULTS: The three year survival rate was 81.0%. The three year survival rates for stages I,II were both 100%. For stages III, IV, the rates were 83.3%, 87.5%, respectively. The three year survival rate for T1, T2, T3 were 100%, 92.3%, 40.0%, respectively. CONCLUSION: Neoadjuvant chemotherapy and radiotherapy would be effective treatment modality for tonsillar neoplasm with high survival rate and low morbidity.
Busan ; Carcinoma, Squamous Cell* ; Drug Therapy* ; Humans ; Medical Records ; Palatine Tonsil* ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms

OBJECTIVETo discuss treatment options for tonsillar squamous cell carcinoma.

METHODSA total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma, treated between 1984 and 2000, were reviewed, including 82 men and 26 women, with ages ranging from 19 to 70 years. Treatments consisted of either radiotherapy and surgery reserved as salvage treatment (Salvage Surgery, 83 patients), or planned surgery with preoperative radiation (Planned Surgery, 25 patients). Radiotherapy was delivered primarily in a dosage of 60 - 70 Gy for Salvage Surgery patients and 40 - 50 Gy for Planned Surgery patients. Both salvage and planned surgeries were radical, with resection of the lateral oropharyngeal wall, segmental resection of the mandible and neck dissection. The pectoralis major myocutaneous flaps were used to repair surgical defects.

RESULTSThe percentages of radical surgery used in the Salvage Surgery and Planned Surgery groups were 24.1% (20/83) and 88.0% (22/25), respectively (P = 0.000). The local recurrence rates were 28.9% (24/83) and 20.0% (5/25) in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.378). The neck recurrence rates were 9.6% (8/83) and 8.0% (2/25) in the Salvage Surgery and Planned Surgery groups respectively (P = 0.804). The 5-year survival rates were 59.3% and 55.3% in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.7056).

CONCLUSIONSAlthough the two treatments had a similar survival rate, Salvage Surgery avoided 60% commando operations compared with the Planned Surgery group, which benefits to recovery of oral functions. Primary radiotherapy is recommended as the treatment of choice for tonsillar squamous cell carcinoma. After radical radiotherapy, salvage surgery should be undertaken in the case of tumor remnants or recurrences.

Adult ; Aged ; Carcinoma, Squamous Cell ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Salvage Therapy ; Tonsillar Neoplasms ; therapy ; Treatment Outcome

This paper reports a case of recurrence of tonsillar cancer on the right 6 months after radiotherapy with pharyngeal hemorrhage for 4 days and aggravation in the next day. The pharyngeal hemorrhage was severe in the case and the maximum of single amount of bleeding was approximately 200 ml. The examination showed active bleeding on the ulcer with a diameter of 2 cm in the right tonsil and the depth of 1 cm. After repeated compression hemostasis proved to be invalid, selective embolization was applied on the patient and the symtoms of pharyngeal hemorrhage disappeared without complications. The patient was discharged after 2 weeks of observation without any recurrence of hemorrhage.
Embolization, Therapeutic ; methods ; Hemorrhage ; etiology ; therapy ; Hemostasis ; Humans ; Neoplasm Recurrence, Local ; Palatine Tonsil ; Pharyngeal Diseases ; etiology ; therapy ; Recurrence ; Tonsillar Neoplasms ; complications

OBJECTIVE: To evaluate the treatment of advanced tonsillar carcinoma by radiotherapy plus salvage surgery (R+S) or surgery coupling with postoperative radiotherapy (S+R). METHOD: Clinical data of 48 patients with advanced tonsillar carcinoma who were treated in The 2nd Affiliated Hospital of Sun Yat-sen University from June 1996 to June 2004 was retrospectively analyzed. The patients were divided into R+S group (group A, 21 cases) and S+R group (group B, 27 cases). Treatment outcomes were compared between these two groups. The QOL (quality of life) scale of Washington University (UW-QOL) was used to investigate the patient's quality of life. RESULT: The 5-year survival rates were 42.9% in group A and 45.8% in group B, there was no significant statistical difference between the two groups (P < 0.05). Both the two treatment modalities could reduce the QOL in some degree. The average QOL score of 46 patients was 661.00 +/- 98.52 , group A was 696.09 + 90.70, while group B was 631.52 +/- 96.74, there was a significant statistical difference between the two groups (P < 0.05). CONCLUSION The two treatment modalities reached similar survivals. However, compared with the S+R, some patients who accepted treatment of R+S could avoid composite resection, reduce functional lesion and improve the QOL.
Adult ; Aged ; Carcinoma, Squamous Cell ; radiotherapy ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; radiotherapy ; surgery ; therapy ; Treatment Outcome

PURPOSE: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in oropharyngeal cancerin terms of survival rates and to identify prognostic factors affecting survival by retrospective analysis. METHODS AND MATERIALS: Forty seven patients of oropharyngeal cancer were treated by conventional radiotherapy in our hospital from Nov. 1985 to Apr.1993. Of these. twenty six patients were treated by conventional radio therapy alone. and 21 patients with neoadjuvant chemotherapy of mostly two or more cycles of cisplatin and pepleomycin. The patient characteristics of radiotherapy alone group and neoadjuvant chemotherapy group were not different generally. Radiotherapy was performed by 6MV-LINAC and the total radiation doses of primary tumors were 54.0-79.2 Gy and cervical lymph nodes were 55.8-90.0 Gy with a fraction size of 1.8 or 2.0 Gy per day. The rangeof follow-up periods was 3-102 months and median was 20 months. The range of age was 33-79 years old and median was 58 years old. RESULTS: Overall 3-year actuarial survival rate (3YSR) of all patients was 39%. The 3YSRs of stage I (n=5), II (n=11), III (n=12) and IV (n=19) were 60, 55,33 and 32% respectively. The 3YSRs of T1+2, T3+4 and No, N+ were 55, 18% (p=0.005) and 43,36% (p>0.1), respectively. There was no difference in 3YSRs between radiotherapy alone group and neoadjuvant chemotherapy group (38 vs 43%, p>0.1). According to the original site of primary tumor, the 3YSRs of tonsil (n=32), base of tongue (n=8), soft palate or uvula(n=6) and pharyngeal wall (n=1) were 36,38,67 and 0%, respectively. The patients of soft palateor uvular cancer had longer survival than other primaries but the difference was not significant statistically (p>0.1). Of 32 patients of tonsillar cancer, 22 patients who had primary extension to adjacent tissue showed inferior survival rate to the ones who had not primary extension, but the difference was marginally significant (24 vs 60%, p=0.08). On Cox multivariate analysis in entire patients with variables of age. T stage. N stage. total duration of radiotherapy, the site of primary tumor and the use of neoadjuvant chemotherapy. only T stage was a significant prognostic factor affecting 3YSR. CONCLUSION: The difference of 3YASRs of conventional radiotherapy alone group and neoadjuvant chemotherapy group was not significant statistically. These treatments could be effective in oropharyngeal cancer of early stage, especially such as soft palate, uvular or tonsillar cancer which did not extend to adjacent tissue. But in order to improve the survival of patients of most advanced oropharyngeal caner, other altered fractionated radiotherapy such as hyperfractionation rather than conventional fractionation or multimodel approach combining radiotherapy and accessible surgery or concurrent chemotherapy might be beneficial.
Cisplatin ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Middle Aged ; Multivariate Analysis ; Oropharyngeal Neoplasms* ; Palate, Soft ; Palatine Tonsil ; Peplomycin ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tongue ; Tonsillar Neoplasms

Dermatomyositis is a rare and idiopathic inflammatory myopathy with characteristic cutaneous manifestations. A 61-year-old female presented with the chief complaints of proximal muscle weakness, facial edema and erythema on the face, chest and back. The patient was diagnosed with dermatomyositis by the clinical manifestation, laboratory findings and an electromyogram. After a year following appropriate treatment, a tonsil cancer was found. The patient was treated with three rounds of neoadjuvant chemotherapy and wide excision of the left tonsil. In Korea, a few cases of dermatomyositis have been reported associated with stomach cancer, breast cancer, acute lymphoblastic leukemia and lung cancer, but no associated cases with tonsil cancer have yet been reported. We report a case of tonsil cancer that developed in a patient with dermatomyosits during therapy.
Breast Neoplasms ; Dermatomyositis* ; Drug Therapy ; Edema ; Erythema ; Female ; Humans ; Korea ; Lung Neoplasms ; Middle Aged ; Muscle Weakness ; Myositis ; Palatine Tonsil* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Stomach Neoplasms ; Thorax ; Tonsillar Neoplasms*

OBJECTIVETo retrospectively analyze the therapeutic effect on patients with tonsillar carcinoma and factors affecting their prognosis.

METHODSClinical data of 61 patients pathologically confirmed with tonsillar carcinoma without distant metastasis were analyzed. All the patients were treated in Cancer Center of Sun Yat-sen University from April 1997 to April 2008. There were 2 patients with undifferentiated carcinoma, 26 with poorly differentiated squamous cell carcinoma and 33 with median-well differentiated squamous cell carcinoma. According to the AJCC 2002 staging criteria for head-neck cancers, there were 9 staged I cases, 7 staged II cases, 23 staged III cases and 22 staged IV cases. The treatment was radiotherapy alone in 27 cases, radiotherapy combined with chemotherapy in 23 cases, surgery combined with postoperative radiotherapy in 6 cases, neoadjuvant chemotherapy plus surgery combined with postoperative radiotherapy in 3 cases, radiotherapy with salvage surgery in 2 cases.

RESULTSThe overall 5-year survival rate was 50.2%. For 16 cases with staged I-II staged, there were 8 cases with radiotherapy alone, 5 years survival was 50.0%, 6 cases with surgery combined with postoperative radiotherapy, 5 years survival was 83.3%. The difference between the two treatments was not significant in statistics (P = 0.318). For III-IV staged 45 cases, there were 19 cases with simple radiotherapy, 5 years survival was 51.5%, 21 cases with radiotherapy combined with chemotherapy, 5 years survival was 36.4%, 5 cases with surgery combined with postoperative radiotherapy, 5 years survival was 75.0%. The difference among the three treatments was not significant in statistics (P = 0.239). According to T stages, the 5-year survival rates of stage T1-T4 cases were 91.8%, 46.8%, 29.1%, 0% respectively (chi(2) = 30.168, P < 0.001). Multivariate analysis demonstrated that T stage, therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors (P < 0.05).

CONCLUSIONST stage, the therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors. For I-II staged tonsillar tumor cases, based on organ preservation, were tendency to choice simple radiotherapy. For III-IV staged cases, yet the relationships between therapeutic mode and therapeutic effect still need further researches.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; diagnosis ; pathology ; therapy