TONSIL CANCER - PATTERNS OF FAILURE AFTER SURGERY ALONE AND SURGERY COMBINED WITH POSTOPERATIVE RADIATION-THERAPY

Background. The authors determined the patterns of treatment failure i n patients treated with surgery alone or surgery combined with postope rative radiation therapy for squamous cell carcinoma of the tonsil. Me thods. Seventy-two patients underwent surgery alone (56) or surgery an d postoperative adjuvant radiation therapy (16). All patients were fol lowed up until death (40 patients) or for a minimum of 3.5 years. For patients treated With surgery alone, clinic notes, operative notes, an d pathology reports and slides were reviewed to identify clinical or p athologic predictors of recurrence above the clavicles, cause-specific survival, and overall survival, For patients undergoing postoperative adjuvant radiation therapy, demographic, treatment, and pathologic va riables were analyzed to identify factors associated with control of d isease above the clavicles, disease-free survival, and overall surviva l. Results. The main pattern of treatment failure was above the clavic les. It occurred in 39% of patients treated with surgery alone and was significantly related (P = 0.002) to the overall clinical TNM stage. Disease recurrence above the clavicles occurred in 31% of patients und ergoing surgery and postoperative adjuvant radiation therapy, despite their more advanced neck disease. Five-year overall survival for patie nts with clinical Stage III and IV disease who were treated with surge ry and postoperative adjuvant radiation therapy was 100% and 78%, resp ectively. Five-year overall survival for patients treated with surgery alone who had clinical Stage III, IVA, or IVB disease was 56%, 43%, a nd 50%, respectively. Conclusion. We recommend postoperative adjuvant radiation therapy for patients with clinical Stage III or IV squamous cell carcinoma of the tonsil who have undergone complete surgical rese ction because this appears to improve control of disease above the cla vicles and overall survival.