Radiation therapy for squamous cell carcinoma of the tonsillar region: A preferred alternative to surgery?

Purpose: There are no definitive randomized studies that compare radiothera py (RT) with surgery for tonsillar cancer. The purpose of this study was to evaluate the results of RT alone and RT combined with a planned neck disse ction for carcinoma of the tonsillar area and to compare these data with th e results of treatment with primary surgery. Patients and Methods: Four hundred patients were treated between October 19 64 and December 1997 and observed for at least 2 years. One hundred forty-o ne patients underwent planned neck dissection, and 18 patients received ind uction (17 patients) or concomitant (one patient) chemotherapy. Results: Five-year local central rates, by tumor stage, were as follows: T1 , 83%; T2, 81%; T3, 74%; and T4, 60%. Multivariate analysis revealed that l ocal control was significantly influenced by tumor stage (P = .0001), fract ionation schedule (P = .0038), and external beam dose (P = .0227). Local co ntrol after RT for early-stage cancers was higher for tonsillar fossa/poste rior pillar cancers than for those arising from the anterior tonsillar pill ar. Five-year cause-specific survival rates, by disease stage, were as foll ows: I, 100%; II, 86%; III, 82%; IVa, 63%; and IVb, 22%. Multivariate analy sis revealed that cause-specific survival was significantly influenced by o verall stage (P = .0001), planned neck dissection (P = .0074), and histolog ic differentiation (P = .0307). The incidence of severe late complications after treatment war 5%. Conclusion: RT alone or combined with a planned neck dissection provides cu re rates that are as good as those after surgery and is associated with a l ower rate of severe complications. J Clin Oncol 18:2219-2225. (C) 2000 by A merican Society of Clinical Oncology.