Primary surgery as treatment for early squamous cell carcinoma of the tonsil

Background. The management of tonsil carcinoma has gradually evolved such t hat the literature is replete with outcome summaries of this disease treate d with primary RT and chemotherapy. Recently there have been no reports of patient outcomes with primary surgical therapy. Nonsurgical treatment is wa rranted when tumors are unresectable or if the patient refuses surgery. Our policy has been to treat operable squamous cell carcinoma (SCCA) of the to nsil with surgery. The decision to use adjuvant therapy is based on the sur gical and histologic findings. We herein report our results with this treat ment protocol. Methods. A retrospective review of 162 patients with SCCA of the tonsil was performed. Eighty-four patients were treated with surgery, which was follo wed by RT and/or chemotherapy if histologic signs of aggressive behavior we re identified. Patients were followed 2 to 15 years after treatment. Results. Of the 9 patients with stage I disease, 89% are without evidence o f recurrent disease and 91% of patients with stage II tonsil cancers are al so disease free. The survival rates for stage III and stage IV cancer patie nts are 79 and 52%, respectively. Conclusion. Our data suggest that patients with early tonsil cancer can be effectively treated with surgery. Surgery allows pathologic staging so that patients with advanced tumors can be treated with adjuvant therapy. (C) 20 00 John Wiley & Sons, Inc.