Objective: To report the oncologic outcomes of transoral laser microsurgery (TLM) in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tonsil. Design: A 2-center prospective case series analysis of TLM in the treatment of tonsil carcinoma. Setting: Academic tertiary referral centers. Patients: Twenty-three patients were treated with TLM between 1996 and 2005. Sixteen of these were TX NX with persistent or locally recurrent disease at a previously treated primary site. The estimated T stage of these patients was T1, 5; T2, 6; T3, 4; and T4, 1. Seven of the 23 patients had second primary tumors within previously treated fields staged as follows: T1, 3; T2, 3; and T3 1. Previous treatment included radiotherapy, chemotherapy, surgery, or a combination of some or all of these. Neck dissections were performed in 9 of 23 patients. Three of 23 patients received postoperative radiotherapy. Median follow-up was 14 months; mean, 23 months; range, 1 to 71 months. Interventions: Transoral laser microsurgery with or without neck dissection, adjuvant radiotherapy, or adjuvant chemotherapy. Main Outcome Measures: Local and locoregional control and recurrence-free and overall survival. Results: The 5-year Kaplan-Meier estimates were as follows: local control, 98%; recurrence-free survival, 81%; and overall survival, 78%. The average duration of hospital stay was 2 days. Three patients (13%) experienced postoperative hemorrhage. Conclusions: Transoral laser microsurgery is a safe and effective treatment for select persistent, recurrent, and second primary squamous cell carcinoma of the tonsil.
Archives of Otolaryngology - Head & Neck Surgery – American Medical Association
Published: Aug 1, 2006