The rate of curability of cancers of the oropharynx varies depending on the stage and specific site. Local control rates for early base-of-tongue cancers approximate 85%. In a large retrospective study involving 262 patients with base-of-tongue cancer, the overall 5-year disease-specific survival rate for patients with all stages of disease was approximately 50%. Treatment modalities included surgery with and without radiation therapy and radiation therapy alone. None of the treatment modalities had a significant survival advantage either overall or within the stages.[44,45]
In a retrospective study involving 162 patients with tonsil carcinoma, 84 patients were treated with primary surgery, which was followed by radiation therapy and/or chemotherapy if histologic signs of aggressive behavior were identified. Survival rates were 89% for stage I, 91% for stage II, 79% for stage III, and 52% for stage IV. In a retrospective study of 188 patients with SCC of the soft palate, uvula, and anterior tonsillar pillar, treatment to the primary site consisted of radiation therapy for 150 patients, surgery for 28 patients, and combined therapy for 10 patients. The overall determinant survival was 80% at 2 years, but it fell to 67% at 5 years. In another retrospective study, 148 patients received definitive radiation therapy for SCC of the pharyngeal wall. Cause-specific survival rates were 89% for stage I, 88% for stage II, 44% for stage III, and 34% for stage IV. Twice-daily fractionation, stage I to stage II disease, and an oropharyngeal primary site were associated with improved locoregional control.
HPV-positive oropharyngeal cancers may represent a distinct disease entity that is causally associated with HPV infection and that is also associated with an improved prognosis. Several studies indicate that individuals with HPV-positive tumors have significantly improved survivals.[10,49,50] In a prospective study involving 253 patients with newly diagnosed or recurrent head and neck SCC, HPV was detected in 25% of the cases. Poor tumor grade and an oropharyngeal site independently increased the probability of HPV presence.
The risk of developing a second primary tumor in patients with tumors of the upper aerodigestive tract has been estimated to be 3% to 7% per year.[51,52] Because of this risk, surveillance of these patients should be lifelong. Patients should be counseled that continued smoking and alcohol consumption after treatment has been associated with the development of second primary tumors of the aerodigestive tract.[53,54,55] (Refer to the PDQ Smoking Cessation and Continued Risk in Cancer Patients summary for more information.)
To date, SCC of the oropharynx has not been associated with any specific chromosomal or genetic abnormalities. Genetic/chromosomal aberrations in these cancers are complex.[56,57] Despite the lack of specific genetic abnormalities, testing for genetic alterations or ploidy in early oropharyngeal lesions may identify patients who are at the greatest risk for progression and may lead to more definitive therapy.
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