Favorable patient reported outcomes following IMRT for early carcinomas of the tonsillar fossa: Results from a symptom assessment study.

BACKGROUND: A questionnaire-based study was conducted to assess long-term patient reported outcomes (PROs) following definitive IMRT-based treatment for early stage carcinomas of the tonsillar fossa. METHODS: Participants had received IMRT with or without systemic therapy for squamous carcinoma of the tonsillar fossa (T1-2 and N0-2b) with a minimum follow-up of 2years. Patients completed a validated head and neck cancer-specific PRO instrument, the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Symptoms were compared between treatment groups of interest and overall symptom burden was evaluated. RESULTS: Of 139 participants analyzed, 51% had received ipsilateral neck IMRT, and 62% single modality IMRT alone (no systemic therapy). There were no differences in mean severity ratings for the top-ranked individual symptoms or symptom interference for those treated with bilateral versus ipsilateral neck IMRT alone. However, 40% of those treated with bilateral versus 25% of those treated with ipsilateral neck RT alone reported moderate-to-severe levels of dry mouth (p=0.03). Fatigue, numbness/tingling, and constipation were rated more severe for those who had received systemic therapy (p<0.05 for each), but absolute differences were small. Overall, 51% had no more than mild symptom ratings across all 22 symptoms assessed. CONCLUSIONS: The long-term patient reported symptom profile in this cohort of tonsil cancer survivors treated with definitive IMRT-based treatment showed a majority of patients with no more than mild symptoms, low symptom interference, and provides an opportunity for future comparison studies with other treatment approaches.

Evaluation of the utility of histopathologic exam as a routine in tonsillectomies.

UNLABELLED: Tonsillectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. OBJECTIVE: Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. METHODOLOGY: retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. RESULTS: 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. DISCUSSION: The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. CONCLUSION: Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams.

Avaliação da utilidade do exame histopatológico como rotina em tonsilectomias / Evaluation of the utility of histopathologic exam as a routine in tonsillectomies

A tonsilectomia é uma das cirurgias mais realizadas em todo o mundo. Apresenta uma grande variedade de indicações, seja em adultos ou crianças. É comum o envio do material retirado para exame histopatológico, seja para análise de material suspeito ou como documentação médico-legal de prova de remoção. OBJETIVO: Avaliar a necessidade e o custo do exame histopatológico de rotina para tonsilectomias. METODOLOGIA: Revisado o resultado histopatológico de todas as tonsilectomias no período de 1978 a 2004 num hospital universitário e analisado o prontuário dos casos encontrados de malignidade. RESULTADOS: Um total de 2.103 resultados de análise histopatológica foi analisado. Desta amostra, apenas quatro casos apresentaram algum tipo de malignidade, sendo todas elas linfomas do tipo não-Hodgkin e já suspeitados antes da cirurgia.DISCUSÃO: A literatura mundial encontra resultados semelhantes e cada vez mais se avalia o envio para análise de todos os casos de tonsilectomia. O custo do exame é alto e seu resultado, nos casos de malignidade, pôde ser previsto em todos os casos antes da cirurgia. CONCLUSÃO: Análise histopatológica de todas as tonsilectomias de rotina não está indicada. Os fatores de risco estabelecidos por Beaty deveriam guiar a solicitação de análise histopatológica, para assim conseguirmos diminuir os custos com exames desnecessários.

Microscopic examination of routine tonsillectomy specimens: is it necessary?

Controversy continues to exist regarding the routine histologic examining of tonsillectomy specimens. Proponents suggest that among other reasons, missing an important diagnosis such as occult malignancy or granulomatous disease and possible medicolegal consequences argue in favor of routine histologic examination. Others state that we should consider the very low yield of significant histologic findings in routine tonsillectomy specimens and its added cost. We performed a retrospective evaluation of all cases of patients who underwent tonsillectomy with or without adenoidectomy between January 1992 and July 1996. Two hundred eighty-eight charts were evaluable. Group 1 consisted of all tonsillectomy specimens that were subjected to gross examination only. Group 2 consisted of all tonsillectomy specimens that were subjected to gross examination as well as microscopic examination. In group 1, no abnormal gross findings were noted. Group 2 consisted of specimens from an older population with a mean age of 21.6 years. There were 43 patients older than 20 years old in group 2, and in all cases except four the preoperative clinical impression correlated with the microscopic findings. Occult malignancy was found in only one of these four patients. No cases of granulomatous disease were discovered. Overall, no patients except one had any change in postoperative treatment on the basis of the results of microscopic examination. We believe that routine microscopic examination of tonsillectomy specimens results in unnecessary cost and consumption of resources and time. Microscopic examination should be done in only selected cases such as in patients with grossly asymmetric tonsils or in patients with a history of malignancy.