Radiation Therapy for Squamous Cell Carcinoma of the Tonsillar Region?
No definitive randomized studies have been conducted that compare radiotherapy (RT) with surgery for tonsillar cancer. In this study, we sought to evaluate the results of RT alone and RT combined with a planned neck dissection for carcinoma of the tonsillar area and to compare these data with the results of treatment with primary surgery.

A total of 400 patients were treated between October 1964 and December 1997 and observed for at least 2 years. One hundred forty-one patients underwent planned neck dissection, and 18 patients received either induction chemotherapy (n=17) or concomitant chemotherapy (n=1).

Five-year local control rates by tumor stage were: T1, 83%; T2, 81%; T3, 74%; and T4, 60%. Multivariate analysis revealed that local control was significantly influenced by tumor stage (P = .0001), fractionation schedule (P = .0038), and external beam dose (P = .0227). Local control after RT for early-stage cancers was higher for tonsillar fossa/posterior pillar cancers than for those originating from the anterior tonsillar pillar. Five-year cause-specific survival rates by disease stage were: I, 100%; II, 86%; III, 82%; IVA, 63%; and IVB, 22%. Multivariate analysis revealed that cause-specific survival was significantly influenced by overall stage (P = .0001), planned neck dissection (P = .0074), and histologic differentiation (P = .0307). The incidence of severe late complications after treatment was 5%.

Study findings concluded that RT alone, or combined with a planned neck dissection, provides cure rates that are as good as those following surgery and is associated with a lower rate of severe complications.