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Five-Year Outcomes of Squamous Cell Carcinoma of the Tonsil Treated With Radiotherapy

Mourad, Waleed F. MD, MSc, PhD*; Hu, Kenneth S. MD*; Puckett, Lindsay MD*; Hauerstock, David MD*; Shourbaji, Rania A. MPH*; Li, Zujun MD; Manolidis, Spiros MD; Schantz, Stimson MD; Tran, Theresa MD; Jacobson, Adam MD; Urken, Mark MD; Culliney, Bruce MD; Persky, Mark MD; Harrison, Louis B. MD*

American Journal of Clinical Oncology: February 2014 - Volume 37 - Issue 1 - p 57–62
doi: 10.1097/COC.0b013e31826b9920
Original Articles: Head & Neck

Purpose: To retrospectively review our single institution experience of patients with tonsillar squamous cell carcinoma.

Material and Methods: Between 1999 and 2005, a total of 79 patients were identified. Stage distribution was as follows: stages I-II, III, IVA, and IVB were in 6, 14, 43, and 16 patients, respectively. Sixty-three patients (80%) were male. Median age was 55.5 years. Treatment generally consisted of external beam radiation therapy (RT) (median dose, 70 Gy), concomitant chemotherapy (CCRT) (cisplatin 100 mg/m2 on days 1, 22, and 43), and neck dissection (ND), and was administered as follows: stages I/II, 6 patients received RT alone; stages III/IVA, 20, 5, and 32 patients received RT alone, CCRT, and CCRT followed by ND, respectively; stage IVB, 9 and 7 patients received CCRT and CCRT plus ND, respectively.

Results: After a median follow-up of 56 months (range, 12 to 122 mo), the 5-year local control (LC), regional control (RC), distant control (DC), and overall survival (OS) by stage were as follows: stage I-II 100%, 100%, 100%, 100%; stage III-IVA 98%, 96%, 95%, and 88%; stage IVB 100%, 100%, 69%, and 66%, respectively. Among stage IVB patients, DC was significantly lower (P=0.01) and a trend toward lower OS was noted (P=0.08). Long-term percutaneous endoscopic gastrostomy dependence was noted in 3% of them who had received CCRT. The effect of both chemotherapy and ND on treatment outcomes was analyzed; in stage III/IVA patients treated with or without chemotherapy, LC was 97% and 100% (P=0.43); RC was 92% and 100%(P=0.27); and DC was 91% and 94% (P=0.92), respectively. In stage III/IVA, patients treated with CCRT with or without ND, RC was 100% and 88%, respectively (P=0.087).

Conclusions: Primary radiotherapy with or without CCRT followed by ND provides excellent tumor control with acceptable toxicity in treating squamous cell carcinoma of the tonsil.

Departments of *Radiation Oncology

Medical Oncology

Otolaryngology, Beth Israel Medical Center, New York, NY

Presented at the 52nd Annual Meeting of the American Society for Radiation Oncology, October 2010, San Diego, CA.

The authors declare no conflicts of interest.

Reprints: Waleed F. Mourad, MD, MSc, PhD, Department of Radiation Oncology, Beth Israel Medical Center (BIMC), Continuum Cancer Centers of New York (CCCNY), Albert Einstein College of Medicine of Yeshiva University (AECOM), 10 Union Square E. Suite 4 G, New York, NY 10003. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc