CARCINOMA OF THE TONSIL - PROGNOSTIC FACTORS

Objectives: This study was conducted to provide a review of the progno stic factors of tonsillar carcinoma. Design: A retrospective analysis. Setting/Patients: Patients with squamous cell carcinoma of the tonsil , treated in Northern Alberta, at the Cross Cancer Institute from 1975 to 1995 were analyzed using a population-based, head and neck cancer registry. There were 102 patients, 73 male and 29 female, ranging in a ge from 35 years to 83 years, with a mean of 60 years. The clinical st ages were T1: 5 patients; T2: 27 patients, T3: 33 patients; T4: 11 pat ients; and Tx: 3 patients. The nodal stages were N0: 33 patients, N1: 26 patients; N2: 34 patients, N3: 7 patients; Nx: 2 patients. Method: The patients were treated with various modalities: surgery alone: 2 pa tients; surgery plus radiation: 26 patients; radiation treatment alone : 61 patients; and others: 13 patients. Patients were classified accor ding to the UICC TNM 1992 criteria, The overall 5-year Kaplan-Meier su rvival in our series was 39%. The cause-specific 4-year survival was 5 7%. Various prognostic factors and their impact on survival were studi ed, Results: On univariate analysis, the following factors were found to Le significant. Age < 50 vs. > 50 (p = .02); endophytic growth patt ern vs. exophytic growth of the primary (p = .01); ulcerated lesions v s, nonulcerated lesions (p = .000); various T stages (p = .003); clini cal extension vs. no extension of primary disease (p = .02); combined modality of treatment (surgery and radiation treatment) had the best c hance of survival compared to radiation treatment alone (p = .03). Nod al stages NO vs. N+ disease (p = .2); sex of the patient, female vs. m ale (p = .83); and dose of radiation treatment < 5000 cGy vs. > 5000 c Gy (p = .41) were found not to be significant. When the above signific ant factors were stratified according to the stage of the disease, onl y two were significant; ulcerated lesions vs. nonulcerated lesions (p = .04), and the modality of treatment chosen (e.g., radiation alone vs . radiation plus surgery) (p = .02). Conclusions: In this series of pa tients, combined-modity approach using surgery and radiation treatment was found to be the best way to treat carcinoma of the tonsil. Howeve r, each treatment strategy should be individualized taking into accoun t various prognostic factors.