Tonsil Cancers are quite sensitive to radiation and in the early stages have an excellent control rate with radiation alone. The literature review by Parsons showed radiation had identical cure rates with surgery but much lower rates of complications (see Parsons.) Read review here.
Note that much of the data below was
before the use of combined chemo-radiation and modern results are much
higher (especially in stage III and IVa). Whereas most patients are now
treated with combination of chemotherapy and high dose
radiation using IMRT techniques (which has resulted in much better
survival statistics, go here
and here and
here, esp if HPV + go
here). So for advanced
oropharynx cancer the survival rates have need pushed up form the 30 to 50%
range now up to the 70 to 90% range,
Lymphoma of the tonsil is discussed here.
Consider the following information:
NCCN Guidelines: early stage, intermediate stage, advanced stage and recommended radiation dose.
Cure Rates with Radiation Alone
Cure Rates comparing radiation with surgery
more local control data, regional control data and survival data
Local Control Data and Survival Data
Sites of local spread, nodes at risk,
Typical small radiation fields: port1 , port 2 , port 3 , port 4, port 5, isodose
Typical fields for more advanced tonsil cance
picture of squamous cancer in tonsil, picture #2 and picture #3,
picture of lymphoma in tonsil / PET scan , more images here
|Tumor Stage||Control||Node Stage||Control|
|89 - 100%
79 - 94%
59 - 69%
24 - 50%
|95 - 100%
95 - 100%
95 - 100%
68 - 95%
There is some debate as to which is better, surgery or radiation for tonsil cancer, as the study notes below from the University of Florida, many of these patients can be treated entirely with just radiation. The literature review by Parsons also showed radiation had identical cure rates with surgery but much lower rates of complications (see Parsons.)
Radiation Therapy for Squamous Cell Carcinoma of the Tonsillar Region: A Preferred Alternative to Surgery?
By William M. Mendenhall
From the Departments of Radiation Oncology and Otolaryngology, University of Florida College of Medicine, Gainesville, FL. Jurnal of Clinical Oncology, Vol 18, Issue 11 (June), 2000: 2219-2225
PURPOSE: There are no definitive randomized
studies that compare radiotherapy (RT) with surgery for tonsillar cancer. The
purpose of this study was to evaluate the results of RT alone and RT combined
with a planned neck dissection for carcinoma of the tonsillar area and to
compare these data with the results of treatment with primary surgery.
RESULTS: Five-year local control rates, by tumor stage, were as follows: T1, 83%; T2, 81%; T3, 74%; and T4, 60%. Multivariate analysis revealed that local control was significantly influenced by tumor stage (P = .0001), fractionation schedule (P = .0038), and external beam dose (P = .0227). Local control after RT for early-stage cancers was higher for tonsillar fossa/posterior pillar cancers than for those arising from the anterior tonsillar pillar. Five-year cause-specific survival rates, by disease stage, were as follows: I, 100%; II, 86%; III, 82%; IVa, 63%; and IVb, 22%. Multivariate analysis revealed that cause-specific survival was significantly influenced by overall stage (P = .0001), planned neck dissection (P = .0074), and histologic differentiation (P = .0307). The incidence of severe late complications after treatment was 5%.
CONCLUSION: RT alone or combined with a planned neck dissection provides cure rates that are as good as those after surgery and is associated with a lower rate of severe complications.