Francesca De Felice1,2, Pierre Blanchard1,3, Antonin Levy1,3, France Nguyen1, Philippe Gorphe4, François Janot4, Stéphane Temam4, Yungan Tao1. 1. Department of Radiation Oncology, Gustave Roussy, Villejuif, France. 2. Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy. 3. Université Paris-Sud, Faculté de Médecine Kremlin Bicêtre, France. 4. Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France.
Abstract
BACKGROUND: Treatment strategy in squamous cell carcinoma (SCC) of the posterior pharyngeal wall is still being debated. METHODS: We performed a retrospective analysis according to delivered treatment. RESULTS: One hundred eighty patients were treated between 1997 and 2011. Eighty-nine patients (49.4%) received surgery +/- radiotherapy (RT), whereas 91 (50.6%) received definitive RT +/- chemoradiotherapy (RT/CRT). Five-year overall survival (OS) was 33.4%. There was a significant 5-year OS benefit in surgical treatment versus RT/CRT (43% vs 24.1%; p = .002). Multivariate analysis showed that current smokers, T3 to T4 classification, well-differentiated SCC, and nonsurgical treatment were associated with reduced OS. Subgroup analysis showed significant survival benefit of surgical treatment compared with RT/CRT in patients with T1 to T2 but not in T3 to T4 disease. CONCLUSION: Surgical management translated into a survival benefit, even in early T classification. These results should be interpreted with caution for selection bias. Surgery remains the standard of care in localized posterior pharyngeal wall SCC. Primary CRT should be considered for nonoperable disease.
BACKGROUND: Treatment strategy in squamous cell carcinoma (SCC) of the posterior pharyngeal wall is still being debated. METHODS: We performed a retrospective analysis according to delivered treatment. RESULTS: One hundred eighty patients were treated between 1997 and 2011. Eighty-nine patients (49.4%) received surgery +/- radiotherapy (RT), whereas 91 (50.6%) received definitive RT +/- chemoradiotherapy (RT/CRT). Five-year overall survival (OS) was 33.4%. There was a significant 5-year OS benefit in surgical treatment versus RT/CRT (43% vs 24.1%; p = .002). Multivariate analysis showed that current smokers, T3 to T4 classification, well-differentiated SCC, and nonsurgical treatment were associated with reduced OS. Subgroup analysis showed significant survival benefit of surgical treatment compared with RT/CRT in patients with T1 to T2 but not in T3 to T4 disease. CONCLUSION: Surgical management translated into a survival benefit, even in early T classification. These results should be interpreted with caution for selection bias. Surgery remains the standard of care in localized posterior pharyngeal wall SCC. Primary CRT should be considered for nonoperable disease.