An optimal therapeutic approach to the oropharynx is not easily defined because no single therapeutic regimen offers a clear-cut, superior-survival advantage over other regimens. The literature is filled with reports highlighting various therapeutic options but does not contain reports presenting any valid comparative studies of therapeutic options. The ultimate therapeutic choice depends on a careful review of each case, attention to the staging of the neoplasm, the general physical condition of the patient, the emotional status of the patient, the experience of the treating team, and the available treatment facilities.
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Traditionally, surgery and radiation therapy have been the standards for treatment of oropharyngeal cancers. No randomized data are available to compare surgery, radiation therapy, or combined treatment.
A pooled analysis of 6,400 patients from 51 reported series who were treated for base-of-tongue oropharyngeal carcinoma between 1970 and 2000 demonstrated local control rates of 79% (surgery ± radiation) and 76% (radiation), (P = .087); locoregional control was 60% versus 69% (P = .009); 5-year survival was 49% for surgery with or without radiation therapy versus 52% (P = .2) for radiation therapy with or without neck dissection. Severe complications were 32% for the surgery group versus 3.8% for the radiation therapy group (P < .001); fatal complications were 3.5% for the surgery group versus 0.4% for the radiation therapy group (P < .001). Similar findings showed equivalent overall and cause-specific survival between surgery versus radiation for tonsil carcinoma; however, 23% overall and cause-specific survival for severe complications in the surgery group versus 6% overall and cause-specific survival in the radiation therapy group (P < .001).
For patients with early-stage disease, single-modality treatment, usually radiation therapy alone, is preferred; however, emerging surgical techniques, including transoral surgery and transoral robotic surgery, are currently evolving. Nonrandomized comparisons suggest superior quality of life with minimally invasive surgical techniques. Historically, more invasive surgical techniques were associated with inferior quality of life and greater morbidity.
Historically, the post-therapy performance status of patients with base-of-tongue primary tumors appeared to be better after radiation therapy than after surgery. Local control and survival is similar in both treatment options.[3,4] Prospective multicenter trials, including RTOG-1221 (NCT01953952) and ECOG-3311 (NCT01898494), are currently underway comparing transoral surgery approaches with definitive radiation or chemoradiation.