Carcinoma of the tonsil: results of radical irradiation with surgery reserved for radiation failure.

This analysis reviews the treatment results of 58 patients with squamous cell carcinoma of the tonsil who were treated by radical irradiation to the primary, with operation reserved for radiation failures. Postirradiation radical neck dissection was sometimes added as part of the initial treatment plan. The local control and absolute survival rates for T1-T2 lesions were quite good, and complications were minimal. On the other hand, the local control and absolute survival for T3-T4 lesions were only fair, and complications generally more severe, although mandibulectomy for osteonecrosis was not required in this small series. There appears to be no justification for combining operation with radiation in the initial attack for T1-T2 lesions. Although the T1-T2 lesions might as well be cured by operation alone, it would entail the loss of part of the mandible, pharyngeal wall, possibly some tongue and soft palate, and at least one radical neck dissection. At attempt at combining operation and irradiation for some T3 (T4) lesions appears justified by the high failure rate of radical irradiation alone. However, therapeutic zeal should be tempered by the realization that many of these patients are elderly or in poor general health, and an aggressive combined treatment approach may be unrealistic .