Locally Advanced Tonsillar Squamous Cell Carcinoma: Treatment Approach Revisited

Abstract

Surgery and postoperative radiotherapy continues to provide a superior outcome in locally advanced tonsil SCC in patients with surgically resectable disease, good ECOG performance status, and medically operable.

Cribriform Adenocarcinoma of the Tongue and Minor Salivary Gland: Transoral Robotic Surgical Resection

“…Simple excision is fraught with positive margins and recurrences while radical resection offers improved local control at the expense of significant functional deficits. In the past, open mandibulectomy and subsequent free-flap reconstruction were occasionally required when visualization of the tumor was suboptimal [12,13]. However, TORS, with its 3D high-definition vision system and lack of line-of-sight limitations, provides excellent visualization, allowing for superior resection with low rates of positive margins and minimal morbidity, which makes it, along with neck dissection when indicated, an ideal surgical intervention for CATMSG.…”

“…However, CATMSG lacks the cysts and deeply eosinophilic colloid associated with PTC and reliably stains negative for TTF-1 and thyroglobulin markers and positive for cytokeratin, smooth muscle actin, and S-100 protein [4,5]. Furthermore, CATMSG classically has an intact mucosa devoid of ulceration or dysplasia, with a tendency to invade local musculature and adjacent tissues, making initial resection by conventional means difficult [3,4,6,7,12,13,14]. This difficulty was evident in our case, where initial resection failed to obtain negative margins.…”

“…In general, robotic surgery has gained support across many fields due to the benefits of magnification, 3D visualization, tremor filtration, and instrument stabilization [9]. TORS using the da Vinci surgical system for oropharyngeal carcinoma resection offers well-documented local control with or without adjuvant therapy [18], with decreased postoperative complications, decreased long-term morbidity, and shorter operative times and hospital stays compared to conventional transoral or open approaches [10,11,12,13,14,15,16,17,18]. Furthermore, when examining the quality of life, patients treated with TORS alone had a return to baseline functional status and overall quality of life at 12 months with only a modest impact on speech at the 6- and 12-month follow-ups [19].…”

“…These tumors consistently stain positive for cytokeratin markers, smooth muscle actin, and S-100 protein but are negative for thyroglobulin and TTF-1 [4,5,8]. Transoral robotic surgery (TORS) offers excellent visualization and access for resection of tumors of the oro- and hypopharynx, allowing for complete resection with negative margins, sparing patients from highly morbid open procedures with longer hospital stays and increased complications [9,10,11,12,13,14,15,16,17]. This case report highlights the novel use of TORS for excision of this rare variant of CATMSG in the palatine tonsil.…”

Genetic Polymorphisms and Head and Neck Cancer Outcomes: A Review

“…Some anatomic subsites (e.g., larynx and some areas in the oral cavity) appear to have better prognoses, but this may be more related to earlier symptoms leading to diagnosis at an earlier stage. In general, patients with good performance status do better than those with poor performance status, in part, because they can tolerate more aggressive therapies (4)(5)(6). Poor performance status is common in HNC patients because of the risk profile of these patients (heavy tobacco and alcohol exposure), which can lead to significant comorbidities that affect treatment and therefore prognosis (4,5).…”