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Squamous Cell Carcinoma of the Soft Palate, Uvula, and Anterior Faucial Pillar

This retrospective study concerns 188 patients with squamous cell carcinoma of the soft palate, uvula, and anterior faucial pillar treated for cure between 1970 and 1983. Men predominated in the group (1.9:1) and 55% of the patients were between 60 and 70 years old. Mean duration of followup was 56.7 months. TNM stage distribution was 29, 67, 37, and 49 patients for stages I, II, III, and IV respectively; six patients were unstaged because of previous excisional biopsy. Treatment to the primary site consisted of radiotherapy for 150 patients, surgery alone for 28 patients, and combined therapy for 10 patients. Primary control for T stages 1 through 4 was: 91% (31 of 34), 77% (71 of 92), 77% (30 of 39), and 35% (6 of 17), respectively. One hundred twenty-eight patients were N0 at presentation, as compared to 60 patients with regional nodal metastasis. Regional control was obtained in 87.5% of patients with N0 necks and in 76.7% of those with nodal involvement. In patients with primary control, these figures were 89% and 81%. Overall determinant survival was 80% at 2 years, but fell to 67% at 5 years. In addition to advanced tumor stage, the survival rate was reduced by regional lymph node metastasis. Tumor extension to the tongue base diminished survival. Survival was poorer among patients with midline tumors or tumors that extended across the palatine arch (37 patients) than for those with unilateral primary tumors (151 patients) (p < 0.05). Despite similar T-stage distribution, the Incidence of regional nodal metastasis was 49% in the former group, compared with 28% in the latter. In patients with midline or bilateral disease, both sides of the neck are at risk for metastasis and must be included in any therapeutic regimen.