Radiation therapy of carcinoma of the tonsillar region

From 1960 through 1976, 353 consecutive patients with carcinoma of the tonsillar region were primarily treated with radiation therapy. The mean age of patients was 58 years with males predominating (78%). Patients were classified according to a TNM and stage classification. Most of the tumors were large, and the specific site of origin could not be determined in 33% of the patients. The predominant identifiable sites were the soft palate and uvula, 18%, the anterior tonsillar pillar, 18%, and the tonsillar fossa, 13%. Patients were treated with radiation to doses of 6700 rad given in 48 days and 33 fractions using Cobalt 60 radiation. We found a 91.7% control rate for patients with T1 disease and 76.9%, 49.5%, and 25% for T2, T3, and T4 patients, respectively. The overall local control rate was 62.3%. Surgery was used most often in recurrences for Stage III patients. Salvage surgery was carried out in 93 patients. Surgery was more successful in controlling the disease in patients in whom the primary was controlled by irradiation. Overall, the tumors in 43% of the patients who had surgery were subsequently controlled as a result of this treatment. Metastasis occurred rapidly, with 75 of the patients exhibiting metastases by 18 months. Complications were not related to dose but were slightly higher in patients who had surgery (5%). We conclude that radiation therapy is the preferred treatment for Stage I and II squamous cell carcinoma of the tonsillar region. No satisfactory results were obtained in Stage IV; other approaches should be tried.