Patients with squamous cell carcinoma of the tonsil
treated with unilateral radiotherapy demonstrated ipsilateral neck and primary
site cancer control with low risk for contralateral recurrence, according to
data from a retrospective review of patients treated at The University of Texas
M.D. Anderson Cancer Center.
Researchers reviewed outcomes of 102 patients with
squamous cell carcinoma of the tonsil who were treated between 1970 and 2007.
Patients were treated with unilateral radiotherapy techniques that irradiate
the involved tonsil region and ipsilateral neck only. Median follow-up was 3.2
Primary site of disease was restricted to the tonsillar
fossa or pillar with no or minimal involvement of the soft palate. Patients had
TX (n=17), T1 (n=51) or T2 (n=33) disease, with NX (n=3), N0 (n=33), N1 (n=23),
N2a (n=22) or N2b (n=22) neck disease. Researchers said node-negative patients
were mainly observed in earlier years.
Patients were treated with an appositional mixed beam of
photons and electrons (1970-1988), a wedge pair photon technique (1989-2003) or
intensity modulated radiotherapy (2004-current standard).
Gregory M. Chronowski, MD, assistant professor in
radiation oncology at M.D. Anderson Cancer Center, presented findings from this
In this selected group, ipsilateral radiotherapy
offered excellent local control, lower risk for contralateral failure and, in a
limited experience, neck dissection appeared to offer a reasonable salvage for
those patients who fail contralaterally, Chronowski said during his
presentation of the results.
According to researchers, there was 100% locoregional
control at the primary site and ipsilateral neck. Contralateral recurrence
occurred in two patients for a crude rate of 2%. The five-year OS was 95%, DFS
was 96% and five-year freedom from contralateral failure was 96%.
Before radiotherapy, 60% of patients underwent
tonsillectomy. Twenty-six percent underwent excision of a cervical lymph node
or neck dissection. After radiotherapy, 18% of patients underwent ipsilateral
neck dissection; 2% had residual viable disease in the neck.
Among the patients with contralateral recurrence, one
had an isolated neck recurrence and was salvaged with contralateral neck
dissection. The patient is alive and disease free, according to the
researchers. The other patient had recurrence in the contralateral base of
tongue and neck, and died from the disease.
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