title: Primary surgery as treatment for early squamous cell carcinoma of the tonsil.
abstract: BACKGROUND
  The management of tonsil carcinoma has gradually evolved such that the literature is replete with outcome summaries of this disease treated with primary RT and chemotherapy. Recently there have been no reports of patient outcomes with primary surgical therapy. Nonsurgical treatment is warranted when tumors are unresectable or if the patient refuses surgery. Our policy has been to treat operable squamous cell carcinoma (SCCA) of the tonsil with surgery. The decision to use adjuvant therapy is based on the surgical and histologic findings. We herein report our results with this treatment protocol.
  
  
  METHODS
  A retrospective review of 162 patients with SCCA of the tonsil was performed. Eighty-four patients were treated with surgery, which was followed by RT and/or chemotherapy if histologic signs of aggressive behavior were identified. Patients were followed 2 to 15 years after treatment.
  
  
  RESULTS
  Of the 9 patients with stage I disease, 89% are without evidence of recurrent disease and 91% of patients with stage II tonsil cancers are also disease free. The survival rates for stage III and stage IV cancer patients are 79 and 52%, respectively.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, University of Pittsburgh, 200 Lothrop St, Suite 500, Pittsburgh, PA 15213, USA.
authors.forename: L T
authors.initials: LT
authors.lastname: Galati
authors.forename: E N
authors.initials: EN
authors.lastname: Myers
authors.forename: J T
authors.initials: JT
authors.lastname: Johnson
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D014067:Tonsillar Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome