1
|
León X, Neumann E, Holgado A, Vásquez R, Pujol A, Quer M. Oncological results of salvage treatment in patients with oropharynx carcinoma treated with radiotherapy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:8-16. [PMID: 37393035 DOI: 10.1016/j.otoeng.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To evaluate the possibilities of salvage after local recurrence in patients with oropharyngeal carcinomas treated with radiotherapy, and to analyse the prognostic factors related to the final control of the disease. METHODS Retrospective study of 596 patients with oropharyngeal carcinoma treated with radiotherapy during the period 1991-2018. RESULTS One hundred and eighty-one patients (30.4%) had a local recurrence. Of the patients with a local recurrence, 51 (28.2%) were treated with salvage surgery. Variables that were associated with the patient not receiving salvage surgery were age greater than 75 years, tumour location in the posterior hypopharyngeal wall, an initial tumour extent cT4, and a recurrence-free interval of less than 6 months. Five-year specific survival of patients treated with salvage surgery was 19.1% (95% CI: 7.3%-30.9%). Variables that were related to specific survival were extent of recurrence and status of resection margins. Final tumour control was not achieved in any of the patients with extensive recurrence (rpT3-4, n = 25) or positive resection margins (n = 22). CONCLUSION Patients with oropharyngeal carcinomas treated with radiotherapy with local tumour recurrence have a limited prognosis. Most patients (71.8%) were not considered candidates for salvage surgery. The 5-year specific survival of patients treated with salvage surgery was 19.1%.
Collapse
Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; UVIC. Universitat Central de Catalunya, Vic, Spain
| | - Eduard Neumann
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Holgado
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosselin Vásquez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Pujol
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| |
Collapse
|
2
|
Philouze P, Péron J, Poupart M, Pujo K, Buiret G, Céruse P. Salvage surgery for oropharyngeal squamous cell carcinomas: A retrospective study from 2005 to 2013. Head Neck 2017; 39:1744-1750. [PMID: 28557145 DOI: 10.1002/hed.24827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/07/2017] [Accepted: 04/17/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In the case of a locoregional recurrence of oropharyngeal squamous cell carcinoma, the curative standard of care is surgery. Our main purpose of this study was to determine the preoperative prognostic factors that would allow us to select the patients on whom we could expect good results with salvage surgery. METHODS We conducted a monocentric retrospective study from 2005 to 2013. It included all patients treated for a recurrence of oropharyngeal squamous cell carcinoma with surgery. Their initial treatment included radiotherapy. RESULTS Fifty-two patients were included. Poor prognostic factors for survival were the cT status (P = .0039) and local recurrences versus secondary localizations in irradiated areas (P = .016) and a relapse less than a year after the end of the initial treatment (P = .050). Recurrence-free survival was 19% at 5 years. Twenty-nine percent of patients presented local complications, which were mainly fistulas and hemorrhaging at the surgical site. CONCLUSION According to the high morbimortality, it is important to carefully select the right patients for surgery.
Collapse
Affiliation(s)
- Pierre Philouze
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France
| | - Julien Péron
- Biostatistics Department, CHU Lyon Sud, Hospices Civils de Lyon, Pierre, Benité, France
| | - Marc Poupart
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France
| | - Kevin Pujo
- Department of Ear, Nose, and Throat, Valence Hospital, Valence, France
| | - Guillaume Buiret
- Department of Ear, Nose, and Throat, Valence Hospital, Valence, France
| | - Philippe Céruse
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France.,The University of Lyon 1, France
| |
Collapse
|
3
|
Righini CA, Nadour K, Faure C, Rtail R, Morel N, Beneyton V, Reyt E. Salvage surgery after radiotherapy for oropharyngeal cancer. Treatment complications and oncological results. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:11-6. [DOI: 10.1016/j.anorl.2011.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/10/2011] [Accepted: 06/29/2011] [Indexed: 11/30/2022]
|
4
|
Cho KJ, Joo YH, Sun DI, Kim MS. Management of cervical lymph node metastasis in tonsillar squamous cell carcinoma: Is it necessary to treat node-negative contralateral neck? Auris Nasus Larynx 2011; 38:501-7. [DOI: 10.1016/j.anl.2010.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/13/2010] [Accepted: 12/13/2010] [Indexed: 11/29/2022]
|
5
|
Röösli C, Studer G, Stoeckli SJ. Salvage treatment for recurrent oropharyngeal squamous cell carcinoma. Head Neck 2010; 32:989-96. [PMID: 19953618 DOI: 10.1002/hed.21273] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy +/- chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy +/- chemotherapy. METHODS A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). RESULTS The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. CONCLUSIONS Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases.
Collapse
Affiliation(s)
- Christof Röösli
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
| | | | | |
Collapse
|
6
|
Bachar GY, Goh C, Goldstein DP, O'Sullivan B, Irish JC. Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2009. [PMID: 19756684 DOI: 10.1007/s00405‐009‐1070‐0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The objective of this study is to report the longterm outcomes of salvage surgery following local and/or regional failure of tonsillar carcinoma treated with standard fractionation radiotherapy. All cases of carcinoma of the tonsil treated by radical radiotherapy at the Princess Margaret Hospital between January 1970 and December 1990 were reviewed retrospectively. Patients who underwent salvage surgery for local and/or regional recurrent squamous cell carcinoma of the tonsil following radiation therapy were included for analysis. 239 out of 640 patients with tonsillar carcinoma recurred post radiotherapy. 175 patients were deemed candidates for surgical salvage. At the time of the last follow-up, only 13 patients were alive and 162 patients had died. The majority of patients (n = 96, 59%)died with disease. The median time to death was approximately 1.3 years following salvage surgery. The 5-year overall survival rate was 23%. The 5-year cause-specific survival was 40%. The probability of death due to disease was higher than the probability of death due to other causes. Both N-classification and T-classification were found to be significant predictors of time to death. In conclusion,in spite of the fact that the patients in this study had been treated prior to the widespread introduction of altered fractionation and concurrent chemoradiation for advanced tonsil carcinoma, it demonstrates the poor prognosis of recurrent disease. Despite the poor prognosis, 20% of patients will be alive at 5 years and therefore salvage surgery should be considered when possible.
Collapse
Affiliation(s)
- Gideon Y Bachar
- Department of Otolaryngology-Head and Neck Surgery,Princess Margaret Hospital, University of Toronto, Toronto, ON M5G2M9, Canada.
| | | | | | | | | |
Collapse
|
7
|
Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy. Eur Arch Otorhinolaryngol 2009; 267:295-301. [DOI: 10.1007/s00405-009-1070-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 08/05/2009] [Indexed: 11/27/2022]
|
8
|
Murphy BA. Topoisomerases in the treatment of metastatic or recurrent squamous carcinoma of the head and neck. Expert Opin Pharmacother 2006; 6:85-92. [PMID: 15709886 DOI: 10.1517/14656566.6.1.85] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Camptothecins are a class of antineoplastic agents that function via inhibition of topoisomerase I, a critical enzyme involved in DNA replication, transcription and chromosomal structure. Two topoisomerase I inhibitors, topotecan and irinotecan, have been developed and approved for the treatment of solid tumour malignancies. Because of their known activity, these and other camptothecins, such as 9-aminocamptothecin (9-AC), have been evaluated for the treatment of patients with recurrent or metastatic squamous carcinomas of the head and neck. Both 9-AC and topotecan failed to demonstrate consistent activity in this cohort of patients. Irinotecan demonstrated single-agent activity of 20% as first-line therapy for patients with metastatic or recurrent disease; however, efficacy was lacking as a second-line agent. Irinotecan is now being evaluated in combination regimens as first-line therapy for metastatic and recurrent disease. In addition, irinotecan is a potent radiation sensitising agent. Two Phase I trials using irinotecan-containing chemotherapy regimens with concurrent radiation in the primary treatment of head and neck cancer (HNC) patients have been reported. Clarification of the role of irinotecan in the treatment of HNC awaits further studies.
Collapse
Affiliation(s)
- Barbara A Murphy
- Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN 37232-6307, USA.
| |
Collapse
|
9
|
Agra IMG, Carvalho AL, Ulbrich FS, de Campos OD, Martins EP, Magrin J, Kowalski LP. Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 2006; 28:107-13. [PMID: 16388526 DOI: 10.1002/hed.20309] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. METHODS Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. RESULTS The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). CONCLUSION Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis.
Collapse
Affiliation(s)
- Ivan Marcelo Gonçalves Agra
- Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A C Camargo, Rua Professor Antonio Prudente, 211, 01509-900 São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
10
|
Lim YC, Lee SY, Lim JY, Shin HA, Lee JS, Koo BS, Kim SH, Choi EC. Management of Contralateral N0 Neck in Tonsillar Squamous Cell Carcinoma. Laryngoscope 2005; 115:1672-5. [PMID: 16148715 DOI: 10.1097/01.mlg.0000184791.68804.0b] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES It is well established that tonsillar squamous cell carcinomas have a high probability of disseminating to the neck. An ipsilateral neck treatment is mandatory during initial treatment of stages II to IV tonsillar carcinomas. However, as of yet, no consensus exists whether to perform elective contralateral neck management. MATERIALS AND METHODS A retrospective analysis of 43 N0-3 tonsillar cancer patients with contralateral clinically negative necks from 1992 to 2002 was performed. All patients had a contralateral elective neck dissection. Surgical treatment was followed by postoperative radiotherapy in 33 patients. The follow-up period ranged from 2 to 120 (mean 38) months. The Kaplan-Meier method and log-rank test were used to calculate the disease-specific survival rates and prognostic significance of contralateral occult lymph node metastasis. RESULTS Clinically negative, but pathologically positive, contralateral lymph nodes occurred in 16% (7 of 43). Of the 33 cases with an ipsilateral node positive neck, contralateral occult lymph node metastases developed in 21% (7 of 33), in contrast with 0% in ipsilateral N0 necks. On the basis of the clinical staging of the tumor, 5% (1 of 22) of the cases showed lymph node metastases in T2 tumors, 36% (5 of 14) in T3, and 25% (1 of 4) in T4. None of the T1 tumors (3 cases) had pathologically positive lymph nodes (T1 + T2 vs. T3 + T4, P < .05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes (5 year disease-specific survival rate 92% vs. 28%, P = < .05). CONCLUSION The risk of contralateral occult neck involvement in above T3 staged tonsillar squamous cell carcinomas with unilateral metastases was high (approximately 21%), and patients who present with a contralateral metastatic neck have a worse prognosis than those who are staged as N0. Therefore, we advocate an elective contralateral neck treatment in tonsillar squamous cell carcinoma patients with ipsilateral node metastases.
Collapse
Affiliation(s)
- Young Chang Lim
- Department of Otolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Goodwin WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 2000; 110:1-18. [PMID: 10714711 DOI: 10.1097/00005537-200003001-00001] [Citation(s) in RCA: 383] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESES Salvage surgery is widely viewed as a "double-edged sword." It is the best option for many patients with recurrent cancer of the upper aerodigestive tract, especially when original therapy included irradiation, yet it may provide only modest benefit at high personal cost to the patient. The stakes are high because alternatives are of limited value. The primary objective of this study was to fully assess the value of salvage surgical procedures in the treatment of local and regional recurrence. The following hypotheses were developed to focus the study design and data analysis. 1) The efficacy of salvage surgery correlates recurrent stage, recurrent site, and time to presalvage recurrence. 2) The economic and noneconomic costs of salvage surgery increase with higher recurrent stage. 3) Information relating the value of salvage surgery to recurrent stage and recurrent site will be useful to these patients and the physicians who treat them. STUDY DESIGN Two complimentary methods of investigation were used: a meta-analysis of the published literature and a prospective observational study of patients undergoing salvage surgery for recurrent cancer of the upper aerodigestive tract. METHODS The meta-analysis combined 32 published reports to obtain an estimate of average treatment effect for salvage surgery with regard to survival, disease-free survival, surgical complications, and operative mortality. The prospective observational study included detailed data in 109 patients who underwent salvage surgery. In addition to parameters studied in the meta-analysis, we obtained baseline and interval quality of life data (Functional Living Index for Cancer [FLIC] scores), baseline and interval performance status evaluations (Performance Status Scale for Head and Neck Cancer Patients [PSS head and neck scores]), length of hospital stay, and hospital and physician charges, and related this data primarily to recurrent stage, recurrent site, and time to presalvage recurrence. RESULTS The weighted average of 5-year survival in the meta-analysis was 39% in 1,080 patients from 28 different institutions. In the prospective study, median disease-free survival was 17.9 months in 109 patients, and this correlated strongly with recurrent stage, weakly with recurrent site, and not at all with time to presalvage recurrence. Noneconomic costs for patients and economic costs correlated with recurrent stage, but not with site. Baseline FLIC and PSS head and neck scores correlated with recurrent stage, but not with site. After salvage surgery the percentage of patients reaching or exceeding baseline was 51% for FLIC scores, and this differed significantly with recurrent stage. Postoperative interval "success" in PSS head and neck subscale scores for diet and eating in public also correlated with recurrent stage. CONCLUSIONS Overall, the expected efficacy for salvage surgery in patients with recurrent head and neck cancer was surprisingly good, but success was limited and costs were great in stage III and, especially, in stage IV recurrences. A strong correlation of efficacy and noneconomic costs with recurrent stage allowed the creation of expectation profiles that may be useful to patients. Additional systematic clinical research is needed to improve results. In the end, the decision to undergo salvage surgery should be a personal choice made by the patient after honest and compassionate discussion with his or her surgeon.
Collapse
Affiliation(s)
- W J Goodwin
- Department of Otolaryngology, University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, University of Miami/Jackson Memorial Medical Center, Florida 33136, USA
| |
Collapse
|
12
|
Rodriguez J, Point D, Brunin F, Jaulerry C, Brugère J. Chirurgie de l'oropharynx après radiothérapie. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0924-4212(96)81347-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
13
|
Regueiro CA, de la Torre A, Valcárcel FJ, Magallón R, Aragón G. Salvage brachytherapy and salvage surgery for recurrent oropharyngeal carcinoma following radiotherapy. J Laryngol Otol 1995; 109:45-8. [PMID: 7876736 DOI: 10.1017/s0022215100129202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We reviewed 21 patients who underwent salvage treatment after a biopsy of proven locally recurrent carcinoma of the oropharynx. Two of these patients underwent a second salvage treatment after failure of the first. Treatment was performed with Ir192 interstitial implant in 17 cases (13 rT1 and 4 rT2); by surgery in five cases (3 rT1, 1 rT2, 1 rTx), including two patients who had relapsed after salvage treatment with Ir192 implant; and by hyperfractionated external beam irradiation plus concomitant Tegafur chemotherapy in one case (rT3). The primary tumour was controlled in four of the 17 cases (23 per cent) treated with Ir192 implant. Of these four patients, two remained disease-free 42 and 59 months after treatment, one died of nodal metastases eight months after treatment and another of distant metastases 19 months after treatment. Four of the five cases (80 per cent) treated with surgery, including two patients who relapsed after salvage brachytherapy, remained free from local, regional and distant relapse 21, 25, 31 and 56 months after treatment.
Collapse
Affiliation(s)
- C A Regueiro
- Department of Radiation Oncology, Clínica Puerta de Hierro, Madrid, Spain
| | | | | | | | | |
Collapse
|
14
|
Gehanno P, Depondt J, Guedon C, Kebaili C, Koka V. Primary and salvage surgery for cancer of the tonsillar region: a retrospective study of 120 patients. Head Neck 1993; 15:185-9. [PMID: 8491581 DOI: 10.1002/hed.2880150302] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The present series compares results in our head and neck department from primary and salvage surgery for tumors of the tonsillar region from 1978 to 1985. Of 120 consecutively admitted patients, 70 underwent primary surgery followed by irradiation, and 50 underwent salvage surgery after the failure of primary radiotherapy. Follow-up has been continued for the past 6 years. Musculocutaneous flaps were employed in all patients requiring them after the introduction of this reconstructive technique in 1981. The actuarial survival rate after primary surgery was 58% at 3 years and 46% at 5 years. For salvage surgery the figures were 38% and 24%, respectively. This disappointing survival rate in salvage surgery resulted from a higher postoperative mortality (8% versus 1.4% in primary surgery) and from a higher local failure rate (36% versus 14%). The outcome was invariably unfavorable when tonsillar tumors extended into the base of the tongue.
Collapse
Affiliation(s)
- P Gehanno
- ENT Department, Claude Bernard Hospital, Paris, France
| | | | | | | | | |
Collapse
|