A NATIONWIDE STUDY OF THE EPIDEMIOLOGY, TREATMENT AND SURVIVAL OROPHARYNGEAL CARCINOMA IN THE NETHERLANDS

Seven head and neck oncology cooperative groups in the Netherlands hav e reviewed the epidemiology, staging, treatment and survival of oropha ryngeal carcinoma patients treated between 1986 and 1990. In all, 640 patients with squamous cell carcinoma (628, 98%) or undifferentiated c arcinoma (12, 2%) referred for primary treatment were analyzed. The to tal group included 441 males (69%) and 199 females (31%), with a media n age of 59 years (range, 30-92). Tumor distribution tion by subsite w as the tonsillar region (372 patients, 58%), base of the tongue/vallec ula (179, 28%), soft palate/uvula (62, 10%) and posterior oropharyngea l wall (27, 4%). Forty-four patients (7%) had stage I disease 106 (17% ) had stage II disease, 157 (24%) stage III, and 319 (50%) stage IV. S taging was unknown in 14 patients (2%). Radiotherapy was given to the primary tumor in 408 patients (64%), surgery and radiotherapy to 147 ( 23%), surgery alone to 42 (7%), other treatments to 14 (2%) and no tre atment to 29 patients (4%). The 5-year overall survival was 28% and th e 5-year disease-specific survival was 41%. This latter survival was 3 5% in males and 51% in females (P = 0.003). Five-year survival by subs ite was 54% in the soft palate/uvula, 42% in the tonsillar region, 33% in the base of the tongue and 32% in the posterior oropharyngeal wall (P = 0.003). When analyzing survival by stage, 5-year survival in pat ients with stage I disease was 68% and decreased significantly to 27% in stage IV disease (P < 0.001). Best survival occurred in patients tr eated with surgery alone (80%), was less in the group treated by surge ry and radiotherapy (51%), and decreased further in patients treated b y radiotherapy alone (36%) (P< 0.0001). By multivariate analysis, stag e, sex and midline localization were found to be significant prognosti c factors.