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James J. Jaber, MD, PhD; Jonathan Moreira, MD; W. Jeffrey Canar, PhD; Carol M. Bier-Laning, MD

Arch Otolaryngol Head Neck Surg. 2009;135(11):1147-1153.

Objective  To determine the recurrence and survival outcome based on treatment date, type of treatment, stage of disease, and comorbidity and the recurrence and survival differences based on smoking status as a surrogate for human papillomavirus status in veterans treated for tonsillar squamous cell carcinoma (SCC).

Design  Outcome cohort study.

Setting  Tertiary care Department of Veterans Affairs hospital.

Patients  A consecutive sample from 1981 through 2006 of 683 patients treated for oropharyngeal SCC was screened, and 141 patients with tonsillar SCC without distant metastatic spread and a minimum of 2 years of follow-up were included.

Main Outcome Measures  Disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS).

Results  Disease-free survival was significantly better in cohort II (treated during or after 1997) compared with cohort I (treated before 1997) (2- and 5-year DFS, 82% vs 64% and 67% vs 48%; P = .02). Disease-specific survival was better in the surgical vs nonsurgical group (2- and 5-year DSS, 77% vs 46% and 67% vs 30%; P < .001), as was the OS (2- and 5-year OS, 66% vs 41% and 45% vs 23%; P = .005). In subjects with early-stage disease, OS and DSS were not different regardless of treatment type. In subjects with late-stage disease treated most recently (time cohort II), there was significantly better DSS in those receiving surgical vs nonsurgical treatment (2-year DSS, 70% vs 43%; P = .045). Nonsmokers had better OS (94 months vs 41 months; P = .001) and lower incidence of recurrence (8% vs 44%; P = .02).

Conclusion  In veterans treated for tonsillar SCC, we advocate the consideration of a treatment plan that includes surgery for patients presenting with advanced-stage SCC of the tonsil, even in patients with notable comorbidities.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois (Drs Jaber and Bier-Laning); Stritch School of Medicine, Loyola University, Chicago, Illinois (Dr Moreira); Spinal Cord Injury Service (Dr Canar) and Otolaryngology Section, Department of Surgery (Dr Bier-Laning), Hines VA Hospital, Hines, Illinois. Dr Moreira is now with the Department of Medicine, Mayo Clinic, Rochester, Minnesota.

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