ORIGINAL ARTICLE ADVANCED-STAGED TONSILLAR SQUAMOUS CARCINOMA: ORGAN PRESERVATION VERSUS SURGICAL MANAGEMENT OF THE PRIMARY SITE Haider Ali Shirazi, MD, 1 Ranjiv Sivanandan, MD, 2 Richard Goode, MD, 2 Willard E. Fee, MD, 2 Michael J. Kaplan, MD, 2 Harlan A. Pinto, MD, 3 Don R. Goffinet, MD, 1 Quynh-Thu Le, MD 1 1 Department of Radiation Oncology, 875 Blake Wilbur Dr, R. CC-G228, Stanford University, Stanford, CA 94305. E-mail: qle@stanford.edu 2 Department of Otolaryngology/Head & Neck Surgery, Stanford University Medical Center, Stanford, California 3 Department of Medical Oncology, Stanford University Medical Center, Stanford, California Accepted 6 October 2005 Published online 10 February 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.20372 Abstract: Background. Our aim was to review our experi- ence in the management of advanced tonsillar squamous cell carcinoma (SCC) and to compare treatment outcomes between patients treated with and without surgery to the primary site. Methods. The records of 74 patients with advanced-stage tonsillar SCC were reviewed. The median age at diagnosis was 58 years. Thirty-eight patients received definitive surgery to the primary site, and 36 were treated with an organ-preservation approach (OP) using radiotherapy 6 chemotherapy. Results. No significant difference in overall survival (OS) or freedom from relapse (FFR) by treatment was found. T classifi- cation and N status were significant independent predictors on multivariate analysis for OS and FFR. Major late toxicity was noted in 10 patients in the surgical group and nine in the OP group. Conclusion. Patients treated with OP and primary surgery had comparable OS and FFR. T classification and N status were significant independent predictors for tumor relapse and survival. On the basis of these results, we favor organ-preservation ther- apy for patients with advanced-stage tonsillar SCC. V V C 2006 Wiley Periodicals, Inc. Head Neck 28: 587–594, 2006 Keywords: chemotherapy; organ preservation; radiotherapy; surgery; tonsillar carcinoma T onsillar squamous cell carcinoma (SCC) repre- sents 15% to 20% of all oropharyngeal malignan- cies and is the most common type of oropharyn- geal carcinoma. 1 For early-stage tumors, radio- therapy (RT) and surgery have been shown to provide equivalent outcomes. 2 For larger tumors (T3–4 tumors), some authors have reported better tumor control with the combination of surgery and RT over RT alone, but at the cost of higher treatment-related morbidity. 3,4 More recently, the role of surgical resection in primary tonsillar car- cinomas was questioned by Parsons et al, 5 who, in a comprehensive literature review, noted compa- rable rates of local control, locoregional control, and survival in patients treated with primary sur- gery followed by RT and those treated with pri- mary RT 6 neck dissection. However, the rates of severe and fatal complications were significantly higher in patients treated primarily with surgery. Correspondence to: Q.-T. Le Presented at the Annual Meeting of the Radiological Society of North America (RSNA), November 2004, Chicago, Illinois. V V C 2006 Wiley Periodicals, Inc. Treatment Options for Advanced Tonsillar Carcinoma HEAD & NECK—DOI 10.1002/hed July 2006 587