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Unilateral radiotherapy effective treatment for squamous cell carcinoma of the tonsil
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Multidisciplinary Head and Neck Cancer Symposium
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 years.
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 study at the Multidisciplinary Head and Neck Cancer Symposium held in Chandler, Ariz.
“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%.
Prior to 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 disease.
For more information:
- Chronowski GM. #9. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 25-27, 2010; Chandler, Ariz.
