HEAD AND NECK SURGERY

Purpose Early stage oral cavity cancer may be treated by surgery, radiotherapy, or a combination of therapies. Radiotherapy is probably most widely used, but we have had a preference for surgical management in selected cases. The aim of this study is to analyse the outcome from this approach. Methods A retrospective cohort study of cases identified from the computer files of the Sydney Head and Neck cancer Institute at Royal Prince Alfred Hospital was undertaken. Eligible patients were those with T1 or T2 squamous cell carcinoma of the oropharynx, treated with definitive surgery with or without radiotherapy. All neck stages were included. Previously treated patients were excluded. Results A total of 108 patients were identified. M:F ratio was 3:1, median age 60, number of T1 and T2 stages were 32 and 76, while 57 patients were N0, and 51 patients had clinical neck disease. 68 patients underwent post operative radiotherapy. Median follow up was 43 months. At he time of follow up 70 patients were alive with no evidence of disease, 11 were alive with disease, 15 had died with disease, and 11 had died from other causes then the cancer. There was 1 with disease status unknown. Conclusion Surgery provides effective treatment for selective patients with early stage cancer of the oropharynx. It also offers the chance of decreasing or avoiding radiotherapy toxicity. A randomized trial comparing surgery with or without radiotherapy, with radiotherapy with or without chemotherapy is recommended.