Radiation after Tonsillectomy

[CUBuffsgrad98]

New article looks at SEER data PMID: 23599071 (which of course always has holes) and suggests tonsillectomy in addition to RT for early stage tonsil SCC has benefit.

Anyone with experience, how long after tonsillectomy do you wait to sim and start RT (generally speaking)? 4 weeks? 6 weeks?

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[deleted4401]

Hmm. Interesting. Was always told a non oncologic tonsillectomy was akin to a biopsy.
The times it happens, I wait 10-14 days then start.

 

[medgator]

Was always told a non oncologic tonsillectomy was akin to a biopsy. .

I was trained the same way. Wait 2 weeks or so. Treat it no differently than a Bx

 

[CUBuffsgrad98]

Hmm. Interesting. Was always told a non oncologic tonsillectomy was akin to a biopsy.
The times it happens, I wait 10-14 days then start.

Yeah, I was trained basically the same way, but I think it makes sense. Early stage with clean margins has minimal morbidity and is simply less disease burden to treat. Not to mention a lower RT dose (MDA goes to 66 Gy under such circumstances PMID: 19691110).

If it is only delaying things 10 days with no obvious neck masses, might as well take it while doing EUA.

 

[Gfunk6]

If you are going to go down the surgery route, I think it should be taken to its logical conclusion: transoral robotic-assisted surgery + ipsilateral selective lymph node dissection. Then, you may be able to treat to 60 Gy and avoid chemotherapy entirely.

This approach was critically reviewed in the Red Journal a few weeks ago.

 

[CUBuffsgrad98]

If you are going to go down the surgery route, I think it should be taken to its logical conclusion: transoral robotic-assisted surgery + ipsilateral selective lymph node dissection. Then, you may be able to treat to 60 Gy and avoid chemotherapy entirely.

This approach was critically reviewed in the Red Journal a few weeks ago.

This may be ok, but for early stage T1-T2 tonsillar cancer as in the MDA and SEER studies, with a clinically negative neck, it may be overkill. If they are going for EUA a simple tonsillectomy without a robot and slicing open the neck is probably reasonable. For more advanced stage or higher T lesions, this is interesting, not sure how I feel about it, need to review it closer. Sounds like only a few institutions are capable of doing it and doing it right. Plus, it will delay RT much longer than no surgery to the neck. Considering the results are typically good with RT alone in these early situations, adding a neck dissection is a lot to ask, I think.