title: Primary radiotherapy for tonsillar carcinoma: a good alternative to a surgical approach.
abstract: OBJECTIVE
  To review the Notre-Dame hospital experience in the treatment of tonsillar carcinoma with primary radiotherapy and to evaluate the different factors affecting locoregional control (LRC) and survival.
  
  
  METHODS
  We reviewed the records of 164 patients treated consecutively for squamous cell carcinoma of the tonsillar region between January 1990 and June 1999. Our study included 22 T1, 75 T2, 54 T3, and 12 T4 lesions; according to N stage, there were 48 N0, 50 N1, 51 N2, and 15 N3 disease. Overall staging was 6 stage I, 28 stage II, 62 stage III, and 67 stage IV disease. All patients received curative radiotherapy, and 31 patients received chemotherapy either prior to or during treatment with radiotherapy. No patient received surgery as a primary treatment modality.
  
  
  RESULTS
  The median follow-up was 4.2 years for all patients and 5.4 years for alive patients. The overall LRC rate was 72% at 5 years. By T and N stage, local and regional control rates at 5 years were as follows: T1, 82%; T2, 74%; T3, 66%; T4, 65%; N0, 77%; N1, 83%; N2, 65%; and N3, 38%. Significant favourable prognostic factors for LRC on univariate analysis were N stage and global stage. On multivariate analysis, the single favourable prognostic factor was N stage. The overall survival (OS) rate was 57% at 5 years. By T and N stage, OS at 5 years was as follows: T1, 62%; T2, 67%; T3, 45%; T4, 22%; N0, 63%; N1, 70%; N2, 46%; and N3, 32%. Significant prognostic factors for OS on univariate analysis were T stage, N stage, and global stage. Favourable prognostic factors for OS on multivariate analysis were T stage and N stage.
  
  
  CONCLUSIONS
  Lower N stage was a favourable prognostic factor for LRC and OS, whereas lower T stage was a favourable prognostic factor on OS. Our results compare favourably with other single-institution surgical series and justify the role of radiotherapy as a primary treatment modality in early tonsillar carcinoma. Concurrent chemotherapy and radiation therapy is currently our standard of care in advanced tonsillar carcinoma.
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Notre-Dame Hospital,e Montreal University Health Center, Quebec. nicolas.charbonneau@umontreal.ca
authors.forename: Nicolas
authors.initials: N
authors.lastname: Charbonneau
authors.forename: Michel
authors.initials: M
authors.lastname: Gélinas
authors.forename: Pierre
authors.initials: P
authors.lastname: del Vecchio
authors.forename: Louis
authors.initials: L
authors.lastname: Guertin
authors.forename: Daniel
authors.initials: D
authors.lastname: Larochelle
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tabet
authors.forename: Denis
authors.initials: D
authors.lastname: Soulières
authors.forename: Danielle
authors.initials: D
authors.lastname: Charpentier
authors.forename: Phuc Félix
authors.initials: PF
authors.lastname: Nguyen-Tân
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D014067:Tonsillar Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome