title: The treatment of squamous cell carcinoma of the tonsil with neck node metastases.
abstract: BACKGROUND
  Patients with tonsillar carcinoma and neck nodes seen at the clinic are not an uncommon occurrence in head and neck practice. Over the years, treatment has ranged from radical jaw neck dissection to radical neck dissection for the nodes and primary radiotherapy to the primary site. Much controversy exists as to which treatment modality yields the best survival. Certainly, surgery to the oropharynx leads to gross morbidity, with problems of swallowing, speech, and cosmesis, although it has been claimed that radiotherapy with neck dissection yields a lower cure rate.
  
  
  METHODS
  We investigated a retrospective series of 96 patients all of whom had squamous cell carcinoma of the tonsil and associated lymph node metastases. Of these, 44 primary tumors were treated with surgery and 52 with irradiation. All 44 patients in the surgery group had a radical neck dissection, as did all but 12 in the radiotherapy group.
  
  
  RESULTS
  Of the tabulations, patients in good general condition were more likely to receive primary surgery. Overall cause-specific survival for all patients was 69%. Multiple logistic regression revealed no associations; thus, the radiotherapy and surgery groups were well matched. Five-year actuarial survival for those having irradiation was 74%. The five-year survival for the group receiving surgery was 63% (p =.4372). This lack of difference between survival for surgery and radiotherapy was confirmed using Cox's proportional hazards model.
  
  
  CONCLUSIONS
  We conclude that tonsillar carcinoma with lymph nodes can be safely treated by applying appropriate radiotherapy to the tonsillar region and treating the neck with radical surgery, if the disease is more than N1.
authors.affiliation: Department of Otolaryngology/Head & Neck Surgery, University of Liverpool, Duncan Building, Daulby Street, Liverpool L69 3GA, United Kingdom. profasjones@beestoncastle.fsnet.co.uk
authors.forename: Andrew Simpson
authors.initials: AS
authors.lastname: Jones
authors.forename: John Eugene
authors.initials: JE
authors.lastname: Fenton
authors.forename: David John
authors.initials: DJ
authors.lastname: Husband
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*