Carcinoma of the oropharynx. Results of megavoltage radiation therapy in 305 patients.

Three hundred and five patients with oropharyngeal carcinomas received linear accelerator radiation therapy at the Stanford University Medical Center between 1956 and 1973. All were staged by the TNM system, using the UICC Classification of 1962. Actuarial five year survival for patients with tonsil cancers ranged from 50% to 18% for those with T1 and T3 lesions, respectively. Disease-free survival was higher than actuarial survival for patients with T1 and T2 lesions, reflecting an alteration of the latter curves by deaths from intercurrent diseases and second primary malignancies. Actuarial survival for patients with base of the tongue carcinomas was approximately 35% for those with T1 and T2 primary lesions and 22% for patients with T3 carcinomas. Considering all oropharyngeal sites of involvement together, clinically involved cervical lymph nodes were controlled by radiation therapy alone in 60 of 91 patients with N1 nodal involvement (67%), in twelve of 25 with N2 neck disease (48%) and in 46% of those patients with N3 involvement (34 of 74). Eighty-nine percent of patients whose lymph nodes were not controlled by radiation therapy alone also had uncontrolled primary cancers. Over 90% of the patients whole cervical lymph nodes were initially uninvolved remained free of late nodal metastases if at least the regional (first echelon) lymph nodes were included in the primary treatment fields. The results of a randomized trial which compared surgery and radiation therapy alone and the two modalities in combination for the treatment of a limited number of patients with advanced cancers of the oropharynx, supraglottic larynx and hypopharynx suggest that surgery alone is not the treatment of choice.