Carcinoma of the tonsil. Analysis of 162 cases

The treatment of 162 patients with squamous cell carcinoma of the tonsil seen at the University of Virginia Medical Center, Charlottesville, from 1955 through 1974 was reviewed. One hundred four patients form the basis of this report. The patients were grouped by the stage of disease, and then three- and five-year determinate survival, recurrences, distant metastases, and complications were examined. The treatment used was surgery, radiation, or a combination of preoperative radiation and surgery. The overall five-year determinate survival for stage I was 93.3%; stage II, 57%; stage III, 27%; and stage IV, 17%. The five-year determinate survivals of patients treated with surgery alone, radiation, and combination therapy were 88%, 27%, and 32%, respectively. The latter two treatment modalities were biased by a greater proportion of patients with stage III and IV disease, whereas surgery alone included a high proportion of patients with stage I and II disease. Based on this review and those reported in the literature, we recommend radical radiation therapy for stage I and II disease and combination radiation therapy and composite resection for stages III and IV.