Presurgical induction chemotherapy for squamous cell carcinoma of the tonsil

Objectives/Hypothesis: The indications for and efficacy of induction chemotherapy in the management of squamous cell carcinoma of the head and neck is controversial. With the advent of human papillomavirus (HPV)–related cancers, survival has improved significantly. Here we present a group of patients with tonsil cancer treated with induction chemotherapy followed by surgery. Study Design: Retrospective cohort study. Methods: Thirty-eight patients with tonsil cancer were treated with induction chemotherapy, consisting of cisplatin and docetaxel, followed by neck dissection and radical tonsillectomy. Twenty-six patients were HPV+, 28 were nonsmokers or long-term former smokers, and 28 were T1/T2. Fourteen patients required postoperative chemoradiotherapy (CRT). Median follow-up time was 4.1 years. Results: A complete response to induction chemotherapy was achieved in 45% (17) of patients. In total, 76% (29/38) of patients were successfully treated: 53% (20/38) with chemotherapy and surgery alone, and 24% (9/38) required postoperative CRT. Almost 90% (23/26) of HPV+ and half (6/12) of HPV− patients are no evidence of disease (NED). HPV status is a significant prognostic factor (P =.02). Only 38% (5/13) of current smokers were NED compared to 96% (24/25) of nonsmokers (P =.0002). All HPV+ nonsmokers (20/20) were NED at last follow-up. Conclusions: In this study, the primary driver of prognosis was smoking status. HPV status and T stage were also important. The prognosis for HPV+ nonsmokers is extremely good; most likely regardless of treatment. Treatment failures have a poor chance of salvage, irrespective of treatment type. With the major exception of HPV− smokers, induction chemotherapy followed by surgery with selective CRT is a viable treatment option for tonsil cancer. Level of Evidence: 4. Laryngoscope, 130:1206–1211, 2020.