Long-term outcome analysis after surgical salvage for recurrent tonsil carcinoma following radical radiotherapy

  • Gideon Y. Bachar
  • Christopher Goh
  • David P. Goldstein
  • Brian O’Sullivan
  • Jonathan C. Irish
Head and Neck


The objective of this study is to report the long-term 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.


Tonsillar carcinoma Salvage Surgery Radical radiotherapy Outcome 


  1. 1.
    Frisch M, Hjalgrim H, Jaeger AB et al (2000) Changing patterns of tonsillar squamous cell carcinoma in the United States. Cancer Causes Control 11:489–495CrossRefPubMedGoogle Scholar
  2. 2.
    Hicks WL Jr, Kuriakose MA, Loree TR et al (1998) Surgery versus radiation therapy as single-modality treatment of tonsillar fossa carcinoma: the Roswell Park Cancer Institute experience (1971–1991). Laryngoscope 108:1014–1019CrossRefPubMedGoogle Scholar
  3. 3.
    Browman GP, Hodson DI, Mackenzie RJ et al (2001) Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: a systematic review of the published literature with subgroup analysis. Head Neck 23:579–589CrossRefPubMedGoogle Scholar
  4. 4.
    Gehanno P, Depondt J, Guedon C et al (1993) Primary and salvage surgery for cancer of the tonsillar region: a retrospective study of 120 patients. Head Neck 15:185–189CrossRefPubMedGoogle Scholar
  5. 5.
    Mizono GS, Diaz RF, Fu KK et al (1986) Carcinoma of the tonsillar region. Laryngoscope 96:240–244CrossRefPubMedGoogle Scholar
  6. 6.
    Perez CA, Carmichael T, Devineni VR et al (1991) Carcinoma of the tonsillar fossa: a nonrandomized comparison of irradiation alone or combined with surgery: long-term results. Head Neck 13:282–290CrossRefPubMedGoogle Scholar
  7. 7.
    Pignon JP, Bourhis J, Domenge C et al (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet 355:949–955PubMedGoogle Scholar
  8. 8.
    Wong CS, Ang KK, Fletcher GH et al (1989) Definitive radiotherapy for squamous cell carcinoma of the tonsillar fossa. Int J Radiat Oncol Biol Phys 16:657–662PubMedGoogle Scholar
  9. 9.
    Genden EM, Ferlito A, Scully C et al (2003) Current management of tonsillar cancer. Oral Oncol 39:337–342CrossRefPubMedGoogle Scholar
  10. 10.
    Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  11. 11.
    Bataini JP, Asselain B, Jaulerry C et al (1989) A multivariate primary tumour control analysis in 465 patients treated by radical radiotherapy for cancer of the tonsillar region: clinical and treatment parameters as prognostic factors. Radiother Oncol 14:265–277CrossRefPubMedGoogle Scholar
  12. 12.
    Maulard C, Housset M, Delanian S et al (1994) Salvage split course brachytherapy for tonsil and soft palate carcinoma: treatment techniques and results. Laryngoscope 104:359–363CrossRefPubMedGoogle Scholar
  13. 13.
    Mazeron JJ, Langlois D, Glaubiger D et al (1987) Salvage irradiation of oropharyngeal cancers using iridium 192 wire implants: 5-year results of 70 cases. Int J Radiat Oncol Biol Phys 13:957–962PubMedGoogle Scholar
  14. 14.
    Kasler M, Fodor J, Oberna F et al (2008) Salvage surgery for locoregional failure after definitive radiotherapy for base of tongue cancer. In Vivo 22:803–806PubMedGoogle Scholar
  15. 15.
    Richey LM, Shores CG, George J et al (2007) The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer. Otolaryngol Head Neck Surg 136:98–103CrossRefPubMedGoogle Scholar
  16. 16.
    Wu X, Tang P, Qi Y et al (2003) Management of tonsillar squamous cell carcinoma. Chin Med J (Engl) 116:1404–1407Google Scholar
  17. 17.
    Pacheco-Ojeda L, Marandas P, Julieron M et al (1992) Salvage surgery by composite resection for epidermoid carcinoma of the tonsillar region. Arch Otolaryngol Head Neck Surg 118:181–184PubMedGoogle Scholar
  18. 18.
    Suzuki M, Terada A, Ogawa T et al (2007) Salvage surgery for radiation failure in oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma. Nippon Jibiinkoka Gakkai Kaiho 110:461–465CrossRefPubMedGoogle Scholar
  19. 19.
    Lee SC, Shores CG, Weissler MC (2008) Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otolaryngol Head Neck Surg 16:135–140CrossRefPubMedGoogle Scholar
  20. 20.
    Marcial VA, Hanley JA, Ydrach A et al (1980) Tolerance of surgery after radical radiotherapy of carcinoma of the oropharynx. Cancer 46:1910–1912CrossRefPubMedGoogle Scholar
  21. 21.
    Corey JP, Caldarelli DD, Hutchinson JC Jr et al (1986) Surgical complications in patients with head and neck cancer receiving chemotherapy. Arch Otolaryngol Head Neck Surg 112:437–439PubMedGoogle Scholar
  22. 22.
    Posner MR, Weichselbaum RR, Fitzgerald TJ et al (1985) Treatment complications after sequential combination chemotherapy and radiotherapy with or without surgery in previously untreated squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 11:1887–1893PubMedGoogle Scholar
  23. 23.
    Emami B, Bignardi M, Spector GJ et al (1987) Reirradiation of recurrent head and neck cancers. Laryngoscope 97:85–88CrossRefPubMedGoogle Scholar
  24. 24.
    Kao J, Garofalo MC, Milano MT et al (2003) Reirradiation of recurrent and second primary head and neck malignancies: a comprehensive review. Cancer Treat Rev 29:21–30CrossRefPubMedGoogle Scholar
  25. 25.
    Lee N, Chan K, Bekelman JE et al (2007) Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 68:731–740PubMedGoogle Scholar
  26. 26.
    Dawson LA, Myers LL, Bradford CR et al (2001) Conformal re-irradiation of recurrent and new primary head-and-neck cancer. Int J Radiat Oncol Biol Phys 50:377–385CrossRefPubMedGoogle Scholar
  27. 27.
    Nagar YS, Singh S, Datta NR (2004) Chemo-reirradiation in persistent/recurrent head and neck cancers. Jpn J Clin Oncol 34:61–68CrossRefPubMedGoogle Scholar
  28. 28.
    Machtay M, Rosenthal DI, Chalian AA et al (2004) Pilot study of postoperative reirradiation, chemotherapy, and amifostine after surgical salvage for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys 59:72–77PubMedGoogle Scholar
  29. 29.
    Hehr T, Classen J, Belka C et al (2005) Reirradiation alternating with docetaxel and cisplatin in inoperable recurrence of head-and-neck cancer: a prospective phase I/II trial. Int J Radiat Oncol Biol Phys 61:1423–1431PubMedGoogle Scholar
  30. 30.
    Naidu SI, Vieira F, Samant S et al (2005) Targeted intra-arterial chemoradiation for advanced tonsil cancer. Otolaryngol Head Neck Surg 133:882–887CrossRefPubMedGoogle Scholar
  31. 31.
    Fu KK, Pajak TF, Trotti A et al (2000) A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 48:7–16CrossRefPubMedGoogle Scholar
  32. 32.
    Narayan K, Crane CH, Kleid S et al (1999) Planned neck dissection as an adjunct to the management of patients with advanced neck disease treated with definitive radiotherapy: for some or for all? Head Neck 21:606–613CrossRefPubMedGoogle Scholar
  33. 33.
    Posner MR, Hershock DM, Blajman CR et al (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357:1705–1715CrossRefPubMedGoogle Scholar
  34. 34.
    Vermorken JB, Remenar E, van Herpen C et al (2007) Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357:1695–1704CrossRefPubMedGoogle Scholar
  35. 35.
    D’Souza G, Kreimer AR, Viscidi R et al (2007) Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356:1944–1956CrossRefPubMedGoogle Scholar
  36. 36.
    Andrews E, Seaman WT, Webster-Cyriaque J (2009) Oropharyngeal carcinoma in non-smokers and non-drinkers: a role for HPV. Oral Oncol 45:486–491CrossRefPubMedGoogle Scholar
  37. 37.
    Jo S, Juhasz A, Zhang K et al (2009) Human papillomavirus infection as a prognostic factor in oropharyngeal squamous cell carcinomas treated in a prospective phase II clinical trial. Anticancer Res 29:1467–1474PubMedGoogle Scholar
  38. 38.
    Nichols AC, Faquin WC, Westra WH et al (2009) HPV-16 infection predicts treatment outcome in oropharyngeal squamous cell carcinoma. Otolaryngol Head Neck Surg 140:228–234CrossRefPubMedGoogle Scholar
  39. 39.
    Ragin CC, Taioli E (2007) Survival of squamous cell carcinoma of the head and neck in relation to human papillomavirus infection: review and meta-analysis. Int J Cancer 121:1813–1820CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gideon Y. Bachar
    • 1
    • 2
  • Christopher Goh
    • 1
    • 2
  • David P. Goldstein
    • 1
    • 2
  • Brian O’Sullivan
    • 3
  • Jonathan C. Irish
    • 1
    • 2
  1. 1.Department of Otolaryngology—Head and Neck Surgery, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Surgical Oncology, Princess Margaret HospitalUniversity of TorontoTorontoCanada
  3. 3.Department of Radiation Oncology, Princess Margaret HospitalUniversity of TorontoTorontoCanada

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