SURGERY VERSUS RADIATION-THERAPY AS SINGLE-MODALITY TREATMENT OF TONSILLAR FOSSA CARCINOMA - THE ROSWELL-PARK-CANCER-INSTITUTE EXPERIENCE (1971-1991)

Objective: To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single mod ality therapy Methods: From 1971 to 1991 239 patients with Oral pharyn geal cancer were treated at Roswell Park Cancer Institute. Of these pa tients 90 had tonsillar carcinoma. Seventy-six of these patients recei ved either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single-modality therapy and are the subject of this review All patien ts in the radiation arm of this review were surgical candidates who de clined primary surgical therapy. Results: Sixty-three percent of the S A and 80% of the RA treatment groups presented with either stage III o r stage IV disease (P less than or equal to .05). Forty-seven percent of the SA group and 52% of the RA patients had clinically positive reg ional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved reg ion. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA gr oup was 75%, compared with 60% in the RA group (P value was not signif icant). The disease-specific survival (all stages) was 61% in the SA g roup and 37% in the RA group (P less than or equal to .05). The diseas e-free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P less than or equal to .05). Survival m easured against clinical response to radiation therapy, in complete re sponders (all stages) was 83%; by contrast there were no survivors pas t 24 months in the partial response group (P less than or equal to .00 1). Conclusion: The results from this study suggest that for early dis ease (stage I/II), surgery or radiation therapy as single-modality tre atment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single-modality treatment, as measured by ul timate survival and the local control of disease. There is, how ever, a subset of patients with advanced disease who respond to radiation th erapy and whose survival is equivalent to our surgical cohort of patie nts.