title: A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer.
abstract: BACKGROUND
  Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil.
  
  
  METHODS
  A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone.
  
  
  RESULTS
  Median age was 55 years (range 34-76 years) and 28 (68%) patients were male. 35/41 patients (85%) received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78%) had a clinical response. Concomitant chemotherapy was given to 30/41 (73%). All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15%) patients had gastrostomy tubes placed before treatment, and 22 (54%) required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85%) patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months). Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8%) patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively.
  
  
  CONCLUSIONS
  Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.
authors.affiliation: St. James's Institute of Oncology, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, West Yorkshire, UK. Robin.Prestwich@leedsth.nhs.uk
authors.forename: Robin J D
authors.initials: RJ
authors.lastname: Prestwich
authors.forename: Kiran
authors.initials: K
authors.lastname: Kancherla
authors.forename: Didem Colpan
authors.initials: DC
authors.lastname: Oksuz
authors.forename: Deborah
authors.initials: D
authors.lastname: Williamson
authors.forename: Karen E
authors.initials: KE
authors.lastname: Dyker
authors.forename: Catherine
authors.initials: C
authors.lastname: Coyle
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sen
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D014067:Tonsillar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*