Interstitial radiation in the treatment of carcinoma of the tonsillar region

From 1964 to 1972, 69 patients were treated for carcinoma of the tonsillar region; all have been followed for at least 4 years. Sixteen patients (23%) had second primaries, and in 11 they were clearly the cause of death. No irradiated patient has died from primary recurrence after 2 years. The overall 3 year determinate survival rate (NED) for patients treated curatively was 63% (32/51). Twenty-four patients had interstitial implants after preliminary external radiation (usually 4,000 rad in 4 weeks). Local control (2+ years) was obtained in at least 82% (18/22); two clearly had recurrence. Of 12 stage I or II patients, 11 survived at least 2 years without evidence of disease; of 12 stage III or IV patients, seven did. Survival could have been improved by more aggressive management of neck nodes, as shown by results for the patients treated since 1969. While small superficial ulcers frequently occurred in the group with implants, all healed spontaneously in 1--6 months; there were no serious complications. The main advantages of implantation are reduction in serious complications and xerostomia.