Should Tonsillar Carcinoma With Nasopharynx Invasion Alone be Classified as a T4b Disease?

ObjectiveThe aim of this study was to explore the role of nasopharynx (NP) invasion alone in tonsillar carcinoma.Materials and MethodsFrom 1987 to 2005, 32 patients with unresect-able cT4b tonsillar carcinoma were retrospectively divided into two groups: the NP-only group, that included 11 patients with NP invasion alone without fitting other T4 criteria; and the other-T4b group, that included the remaining 21 patients. Local control and overall survival were the main endpoints of interest.ResultsAt the time of this analysis, 28 patients had died, with a median follow-up time for all 32 patients of 13 months (range, 1-228 months). The mean follow-up period for the four living patients was 180 months (range, 125-228 months). When compared with the other T4b patients, patients with NP invasion alone, without fitting other T4 criteria, had greater 5-year local control (63.6% vs. 14.3%, p = 0.026; hazard ratio for local failure, 0.31; 95% confidence interval, 0.11-0.94) and 5-year overall survival (45.5% vs. 10.3%, p = 0.022; hazard ratio for death from any cause, 0.34; 95% confidence interval, 0.13-0.89).ConclusionIn patients with tonsillar carcinoma, nasopharynx invasion alone should not be considered as an independent criterion of T4b classification in the next version of cancer staging.