Role of Surgery in Limited (T1-2, N0-1) Cancers of the Oropharynx

Hypothesis: To define the role of surgical staging in limited (T1-2, N0-1) oropharyngeal squamous cell cancers. Study Design: Retrospective. Methods: Forty-nine limited oropharyngeal squamous cell cancers of the tonsil, tongue base, or posterior pharyngeal wall-treated surgically were identified. Results: Thirty-five percent were cT1 and 65% were cT2 tumors although 58% were cN0 and 42% were cN1. Forty-six patients underwent neck dissections. Surgical staging altered T-stage in 26% (13/49), nodal status in 23% (11/46), and clinical staging in 40% (20/49) of patients. Among 35 disease-free patients, 28% (4/20) of stage I/II patients received postoperative radiation and chemotherapy was avoided in 80% (12/15) of stage III patients. T1 tumors seemed to have better outcomes (P = .06). The 3 year disease-free survival and 5 year overall survival was 85% and 83%, respectively. Conclusions: Surgical staging identifies patients in whom intensification of treatment with chemotherapy can be most appropriately applied, and enables de-intensification of therapy in pathology confirmed stage I/II disease.