Unilateral radiotherapy for the treatment of tonsil cancer

Gregory M. Chronowski, Adam S. Garden, William H. Morrison, Steven J. Frank, David Schwartz, Shalin J. Shah, Beth M. Beadle, G. Brandon Gunn, Michael E. Kupferman, Kian K. Ang, David I. Rosenthal

Research output: Contribution to journalArticle

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Abstract

Purpose: To assess, through a retrospective review, clinical outcomes of patients with squamous cell carcinoma of the tonsil treated at the M. D. Anderson Cancer Center with unilateral radiotherapy techniques that irradiate the involved tonsil region and ipsilateral neck only. Methods and Materials: Of 901 patients with newly diagnosed squamous cell carcinoma of the tonsil treated with radiotherapy at our institution, we identified 102 that were treated using unilateral radiotherapy techniques. All patients had their primary site of disease restricted to the tonsillar fossa or anterior pillar, with <1 cm involvement of the soft palate. Patients had TX (n = 17 patients), T1 (n = 52), or T2 (n = 33) disease, with Nx (n = 3), N0 (n = 33), N1 (n = 23), N2a (n = 21), or N2b (n = 22) neck disease. Results: Sixty-one patients (60%) underwent diagnostic tonsillectomy before radiotherapy. Twenty-seven patients (26%) underwent excision of a cervical lymph node or neck dissection before radiotherapy. Median follow-up for surviving patients was 38 months. Locoregional control at the primary site and ipsilateral neck was 100%. Two patients experienced contralateral nodal recurrence (2%). The 5-year overall survival and disease-free survival rates were 95% and 96%, respectively. The 5-year freedom from contralateral nodal recurrence rate was 96%. Nine patients required feeding tubes during therapy. Of the 2 patients with contralateral recurrence, 1 experienced an isolated neck recurrence and was salvaged with contralateral neck dissection only and remains alive and free of disease. The other patient presented with a contralateral base of tongue tumor and involved cervical lymph node, which may have represented a second primary tumor, and died of disease. Conclusions: Unilateral radiotherapy for patients with TX-T2, N0-N2b primary tonsil carcinoma results in high rates of disease control, with low rates of contralateral nodal failure and a low incidence of acute toxicity requiring gastrostomy.

Original languageEnglish (US)
Pages (from-to)204-209
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number1
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Tonsillar Neoplasms
radiation therapy
Radiotherapy
cancer
Palatine Tonsil
Therapeutics
Neck
Recurrence
dissection
Neck Dissection
lymphatic system
Squamous Cell Carcinoma
tumors
Soft Palate
Neoplasms
Tonsillectomy
Gastrostomy
tongue
Enteral Nutrition

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Chronowski, G. M., Garden, A. S., Morrison, W. H., Frank, S. J., Schwartz, D., Shah, S. J., ... Rosenthal, D. I. (2012). Unilateral radiotherapy for the treatment of tonsil cancer. International Journal of Radiation Oncology Biology Physics, 83(1), 204-209. https://doi.org/10.1016/j.ijrobp.2011.06.1975

Unilateral radiotherapy for the treatment of tonsil cancer. / Chronowski, Gregory M.; Garden, Adam S.; Morrison, William H.; Frank, Steven J.; Schwartz, David; Shah, Shalin J.; Beadle, Beth M.; Gunn, G. Brandon; Kupferman, Michael E.; Ang, Kian K.; Rosenthal, David I.

In: International Journal of Radiation Oncology Biology Physics, Vol. 83, No. 1, 01.05.2012, p. 204-209.

Research output: Contribution to journalArticle

Chronowski, GM, Garden, AS, Morrison, WH, Frank, SJ, Schwartz, D, Shah, SJ, Beadle, BM, Gunn, GB, Kupferman, ME, Ang, KK & Rosenthal, DI 2012, 'Unilateral radiotherapy for the treatment of tonsil cancer', International Journal of Radiation Oncology Biology Physics, vol. 83, no. 1, pp. 204-209. https://doi.org/10.1016/j.ijrobp.2011.06.1975
Chronowski, Gregory M. ; Garden, Adam S. ; Morrison, William H. ; Frank, Steven J. ; Schwartz, David ; Shah, Shalin J. ; Beadle, Beth M. ; Gunn, G. Brandon ; Kupferman, Michael E. ; Ang, Kian K. ; Rosenthal, David I. / Unilateral radiotherapy for the treatment of tonsil cancer. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 83, No. 1. pp. 204-209.
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abstract = "Purpose: To assess, through a retrospective review, clinical outcomes of patients with squamous cell carcinoma of the tonsil treated at the M. D. Anderson Cancer Center with unilateral radiotherapy techniques that irradiate the involved tonsil region and ipsilateral neck only. Methods and Materials: Of 901 patients with newly diagnosed squamous cell carcinoma of the tonsil treated with radiotherapy at our institution, we identified 102 that were treated using unilateral radiotherapy techniques. All patients had their primary site of disease restricted to the tonsillar fossa or anterior pillar, with <1 cm involvement of the soft palate. Patients had TX (n = 17 patients), T1 (n = 52), or T2 (n = 33) disease, with Nx (n = 3), N0 (n = 33), N1 (n = 23), N2a (n = 21), or N2b (n = 22) neck disease. Results: Sixty-one patients (60{\%}) underwent diagnostic tonsillectomy before radiotherapy. Twenty-seven patients (26{\%}) underwent excision of a cervical lymph node or neck dissection before radiotherapy. Median follow-up for surviving patients was 38 months. Locoregional control at the primary site and ipsilateral neck was 100{\%}. Two patients experienced contralateral nodal recurrence (2{\%}). The 5-year overall survival and disease-free survival rates were 95{\%} and 96{\%}, respectively. The 5-year freedom from contralateral nodal recurrence rate was 96{\%}. Nine patients required feeding tubes during therapy. Of the 2 patients with contralateral recurrence, 1 experienced an isolated neck recurrence and was salvaged with contralateral neck dissection only and remains alive and free of disease. The other patient presented with a contralateral base of tongue tumor and involved cervical lymph node, which may have represented a second primary tumor, and died of disease. Conclusions: Unilateral radiotherapy for patients with TX-T2, N0-N2b primary tonsil carcinoma results in high rates of disease control, with low rates of contralateral nodal failure and a low incidence of acute toxicity requiring gastrostomy.",
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AU - Beadle, Beth M.

AU - Gunn, G. Brandon

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N2 - Purpose: To assess, through a retrospective review, clinical outcomes of patients with squamous cell carcinoma of the tonsil treated at the M. D. Anderson Cancer Center with unilateral radiotherapy techniques that irradiate the involved tonsil region and ipsilateral neck only. Methods and Materials: Of 901 patients with newly diagnosed squamous cell carcinoma of the tonsil treated with radiotherapy at our institution, we identified 102 that were treated using unilateral radiotherapy techniques. All patients had their primary site of disease restricted to the tonsillar fossa or anterior pillar, with <1 cm involvement of the soft palate. Patients had TX (n = 17 patients), T1 (n = 52), or T2 (n = 33) disease, with Nx (n = 3), N0 (n = 33), N1 (n = 23), N2a (n = 21), or N2b (n = 22) neck disease. Results: Sixty-one patients (60%) underwent diagnostic tonsillectomy before radiotherapy. Twenty-seven patients (26%) underwent excision of a cervical lymph node or neck dissection before radiotherapy. Median follow-up for surviving patients was 38 months. Locoregional control at the primary site and ipsilateral neck was 100%. Two patients experienced contralateral nodal recurrence (2%). The 5-year overall survival and disease-free survival rates were 95% and 96%, respectively. The 5-year freedom from contralateral nodal recurrence rate was 96%. Nine patients required feeding tubes during therapy. Of the 2 patients with contralateral recurrence, 1 experienced an isolated neck recurrence and was salvaged with contralateral neck dissection only and remains alive and free of disease. The other patient presented with a contralateral base of tongue tumor and involved cervical lymph node, which may have represented a second primary tumor, and died of disease. Conclusions: Unilateral radiotherapy for patients with TX-T2, N0-N2b primary tonsil carcinoma results in high rates of disease control, with low rates of contralateral nodal failure and a low incidence of acute toxicity requiring gastrostomy.

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