International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationsCarcinoma of the tonsillar fossa: prognostic factors and long-term therapy outcome
Introduction
Definitive radiation therapy is an effective method of treatment for early-stage tonsillar fossa carcinoma. Extensive lesions that invade the base of the tongue or metastatic cervical lymphadenopathy have less satisfactory tumor control and survival. A combination of preoperative or postoperative irradiation and surgery has been advocated in more advanced disease.
This analysis updates previous reports on the treatment of tonsillar carcinoma at our institution (1), and we analyze prognostic factors, anatomic sites of failure, survival, and sequelae of therapy for various treatment modalities.
Section snippets
Methods and materials
Three hundred eighty-four patients with histologically confirmed epidermoid carcinoma (keratinizing and nonkeratinizing) of the tonsillar fossa were treated with definitive intent at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, between January 1959 and December 1991. All radiation therapy and hospital records and pathology reports were reviewed. A large number of the pathology slides were reviewed as part of a previous study. All patients were
Tumor spread
Only 16 patients (5.4%) had tumor localized to the tonsillar fossa at diagnosis. Tumor extension to adjacent sites, usually multiple, was frequently noted. Overall, tumor spread to the soft palate/anterior tonsillar pillars was recorded in 65% of patients, to the base of the tongue and posterior tonsillar pillar in 44%, to the pharyngeal wall in 31%, and to the vallecula or oral cavity in 10–15%.
Two hundred thirty-two (60%) patients had metastases to the ipsilateral cervical lymph nodes (48% to
Discussion
As in our review, Bataini et al.(4), in a multivariate analysis of 465 patients with tonsillar region cancer treated with irradiation alone (65–68 Gy in 6–7 weeks), noted that the stage and site of the primary tumor were the only significant prognostic factors influencing tumor control. Contrary to our experience, the length of overall treatment time was the only technical variable associated with local tumor control.
Lee et al.(5) updated a report by Mendenhall et al.(6) of 243 patients with
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