Carcinoma of the tonsillar fossa: A nonrandomized comparison of irradiation alone or combined with surgery: Long‐term results

Abstract

The results of therapy are reported in 296 patients with histologically proven epidermoid carcinoma of the tonsillar fossa; 127 were treated with irradiation alone (5,500 to 7,000 cGy), 133 with preoperative radiotherapy (2,000 to 3,000 cGy) or were initially planned for preoperative irradiation but treated with radiotherapy alone, and 36 with postoperative irradiation (5,000 to 6,000 cGy). The operation in all but 4 patients consisted of an en bloc radical tonsillectomy with ipsilateral lymph node dissection. Actuarial 5-year no evidence of disease (NED) was as follows: survival rates for patients with T1 tumors, 76%; T2, 54%; T3, 45%; and T4, 20%. Patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1) had better relapse-free survival (60% to 70% at 5 years) than those with large or fixed lymph nodes (30% to 40%). Primary tumor recurrence rate in the T1-T2 groups was about 20% in patients treated with irradiation and surgery and 30% for those treated with irradiation alone (difference not statistically significant), 30% in patients with stage T3 lesions in all treatment groups, and 33% in patients with T4 disease treated with surgery and postoperative irradiation compared to 52% with irradiation alone (p = 0.03). The overall recurrence rate in the neck was about 20% for the N0 patients, 25% for N1, and 30% for those with N2 and N3 cervical lymph nodes in the 4 treatment groups. The incidence of contralateral neck recurrences was about 8% with the various treatment modalities. Fatal complications were noted in 7 of 133 patients treated with preoperative irradiation in contrast to only 2 (1.5%) of 127 patients treated with radiotherapy alone. Other severe nonfatal sequelae were noted in 33.8% of the patients treated with preoperative irradiation and surgery, in 22% with postoperative irradiation, and in 18% with radiotherapy alone. We conclude that radiotherapy remains the treatment of choice for patients with stage T1-T2 carcinoma of the tonsillar fossa. In selected T3-T4 cases a combination of surgery and postoperative irradiation appears to offer better tumor control, but the possibility of greater morbidity must be considered.