The characteristics and results of therapy in 218 patients with histologically proven epidermoid carcinoma of the tonsillar fossa are reported. Ninety‐eight patients were treated with irradiation alone (5500–7000 rad). One hundred twenty patients were treated with preoperative radiation (2000–3000 rad) and en bloc radical tonsillectomy with ipsilateral lymph node dissection. The actuarial three year survival on patients with T1 tumors was 76%; T2, 40%; T3, 42%; and T4, 25%. The patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1,N2) had better survival (50% at five years) than those with fixed lymph nodes (20%–30%). The primary tumor recurrence rate in the T1–T2 groups was about 20% in the patients treated with preoperative radiation and surgery in contrast to 35% to 40% for those treated with radiation alone. This difference is not statistically significant. The local recurrences in the patients with T3 lesions were 30% with both treatment groups; with T4 lesions recurrences noted in 50% of the patients receiving irradiation alone and 75% in the patients treated with preoperative radiation and surgery. The local recurrence rate in the neck was about 10% for the NO patients, 30% for N1, and 30% for the patients with N2 and N3 cervical lymph nodes. The incidence of contralateral recurrences was about 10% in the various primary tumor or lymph node stage groups. There was no significant difference in the survival or in the frequency of recurrences in the primary or neck in the patients treated with radiation alone or preoperative radiation and surgery. Fatal major complications were noted in eight of the 120 patients treated with preoperative radiation and surgery (6.6%) in contrast to only one in the 98 patients treated with radiation alone. Other less severe complications were noted in 40% of the patients treated with preoperative radiation and surgery and in 32.6% of those treated with radiation therapy alone. Radiation therapy remains the treatment of choice for patients with carcinoma of the tonsillar fossa. In selected cases a combination of both modalities may offer better tumor control, but the possibility of a higher complication rate must be considered.
|Number of pages||9|
|State||Published - Dec 1 1982|