title: Radiation therapy for squamous cell carcinoma of the tonsillar region: a preferred alternative to surgery?
abstract: OBJECTIVE
  There are no definitive randomized studies that compare radiotherapy (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 dissection for carcinoma of the tonsillar area and to compare these data with the results of treatment with primary surgery.
  
  
  METHODS
  Four hundred 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 induction (17 patients) or concomitant (one patient) chemotherapy.
  
  
  RESULTS
  Five-year local control rates, by tumor stage, were as follows: 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 arising from the anterior tonsillar pillar. Five-year cause-specific survival rates, by disease stage, were as follows: 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%.
  
  
  CONCLUSIONS
  RT alone or combined with a planned neck dissection provides cure rates that are as good as those after surgery and is associated with a lower rate of severe complications.
authors.affiliation: Departments of Radiation Oncology and Otolaryngology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA. mendewil@shands.ufl.edu
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: R J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: S P
authors.initials: SP
authors.lastname: Stringer
authors.forename: D B
authors.initials: DB
authors.lastname: Villaret
authors.forename: N J
authors.initials: NJ
authors.lastname: Cassisi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D016019:Survival Analysis; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome