Acupuncture Therapy ; Aged ; Female ; Humans ; Radiotherapy ; adverse effects ; Tonsillar Neoplasms ; radiotherapy ; Xerostomia ; etiology ; therapy

PURPOSE: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. MATERIALS AND METHODS: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. RESULTS: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. CONCLUSION: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucositis ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Tonsillar Neoplasms ; Xerostomia

Epiglottis ; pathology ; Humans ; Palatine Tonsil ; Tissue Adhesions ; diagnosis ; Tonsillar Neoplasms ; radiotherapy

PURPOSE: To evaluate the roles of conventional radiotherapy alone or with neoadjuvant chemotherapy for tonsillar carcinomas and any prognostic factors affecting survivals by retrospective analysis. MATERIALS AND METHODS: Thirty four patients received radical radiotherapy for tonsillar carcinomas from Nov. 1985 to Dec. 1993. Of them, 16 patients were treated by conventional radiotherapy alone and the other 18 patients were received radiotherapy with 1 to 3 cycles of neoadjuvant chemotherapy of cisplatin and 5-fluorouracil or pepleomycin. Radiotherapy was performed by 6MV X-ray with daily fraction of 1.8Gy and the range of primary tumor doses was 55.0-86.4Gy(median 66.6Gy), and that of clinically positive nodal doses was 55.8-90Gy(median 69.7Gy). RESULTS: Overall 5-year actuarial survival rate (5YSR) was 32%. The 5YSRs in stage I+II(n=8), III(n=13) and IV(n=13) were 47%, 29% and 25%, respectively(p=0.33). The 5YSRs in T2(n=13), T3(n=10) and T4 (n=7) were 38%, 27% and 0%, respectively and 3 of 4 patients of T1 are alive with NED at 25, 45, 53 months respectively with statistical significance of the trend in survivals among the four T-stages(p=0.01), and those of node negative(n=14) vs node positive patients(n=20) were 31% vs 32%, respectively(p=0.85). There was no significant survival difference between radiotherapy alone group and with neoadjuvant chemotherapy group(22% vs. 38%, p=0.24). The 5YSRs of 21 patients of primary tumor extension to adjacent sites and the other 13 patients of tonsillar proper site were 28% and 38%, respectively but the difference was not significant statistically(p=0.62). There was a statistically significant difference in 5YSRs between the groups of the patients who received radiotherapy in less than 61days vs more than 60days(60% vs. 18%, p=0.027). All living patients without any tumor progression(n=11) had suffered from serious late sequelae such as xerostomia, edentia, dental caries and one patient had the osteoradionecrosis of mandible. On univariate analysis, the duration of radiotherapy and T-stage were the significant prognostic factors affecting 5YSR. On multivariate analysis, also the duration of radiotherapy was the only significant prognostic factor(p=0.01). CONCLUSION: There was no survival difference between the radiotherapy alone and with neoadjuvant chemotherapy groups. Although it was a retrospective study, the role of conventional radiotherapy alone could be effective as the local treatment modality only for the early stage of tonsillar carcinomas. But for the purpose of more improved survivals and better quality of lives of living patients, other altered fractionation such as hyperfractionated radiotherapy with shorter treatment time and smaller fraction size rather than conventional radiotherapy might be beneficial and these prospective studies are needed.
Cisplatin ; Dental Caries ; Drug Therapy ; Fluorouracil ; Humans ; Mandible ; Multivariate Analysis ; Osteoradionecrosis ; Peplomycin ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; Xerostomia

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this study was to evaluate the efficacy of the neoadjuvant chemotherapy and radiotherapy in the treatment of tonsillar neoplasm. MATERIALS AND METHOD: Medical records of 21 patients who received neoadjuvant chemotherapy and radiotherapy for tonsillar neoplasm at Pusan National University Hospital from April 1995 through August 2000 were retrospectively reviewed. RESULTS: The three year survival rate was 81.0%. The three year survival rates for stages I,II were both 100%. For stages III, IV, the rates were 83.3%, 87.5%, respectively. The three year survival rate for T1, T2, T3 were 100%, 92.3%, 40.0%, respectively. CONCLUSION: Neoadjuvant chemotherapy and radiotherapy would be effective treatment modality for tonsillar neoplasm with high survival rate and low morbidity.
Busan ; Carcinoma, Squamous Cell* ; Drug Therapy* ; Humans ; Medical Records ; Palatine Tonsil* ; Prognosis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms

Grisel's syndrome, defined as the atlanto-axial joint subluxation not associated with a trauma or bone disease, is a rare complication following operative procedure and/or infections of the upper aerodigestive tract. Pathogenetically, it may occur in association with any condition that results in hyperemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. When an inflammation heals, Grisel's syndrome can probably result in a fixation in the rotated position. It is diagnosed by physical and radiological findings. Early management, consisting of cervical immobilization and medical treatment, is considered a key factor for satisfactory outcome. Inappropriate treatment can result in a catastrophic consequence. Recently, we experienced a case of Grisel's syndrome following tonsillectomy in a patient with left palatine tonsillar cancer with preoperative radiotherapy. We report this case with a literature review.
Atlanto-Axial Joint* ; Bone Diseases ; Humans ; Hyperemia ; Immobilization ; Inflammation ; Ligaments ; Radiotherapy* ; Relaxation ; Surgical Procedures, Operative ; Tonsillar Neoplasms* ; Tonsillectomy*

OBJECTIVE: To evaluate the treatment of advanced tonsillar carcinoma by radiotherapy plus salvage surgery (R+S) or surgery coupling with postoperative radiotherapy (S+R). METHOD: Clinical data of 48 patients with advanced tonsillar carcinoma who were treated in The 2nd Affiliated Hospital of Sun Yat-sen University from June 1996 to June 2004 was retrospectively analyzed. The patients were divided into R+S group (group A, 21 cases) and S+R group (group B, 27 cases). Treatment outcomes were compared between these two groups. The QOL (quality of life) scale of Washington University (UW-QOL) was used to investigate the patient's quality of life. RESULT: The 5-year survival rates were 42.9% in group A and 45.8% in group B, there was no significant statistical difference between the two groups (P < 0.05). Both the two treatment modalities could reduce the QOL in some degree. The average QOL score of 46 patients was 661.00 +/- 98.52 , group A was 696.09 + 90.70, while group B was 631.52 +/- 96.74, there was a significant statistical difference between the two groups (P < 0.05). CONCLUSION The two treatment modalities reached similar survivals. However, compared with the S+R, some patients who accepted treatment of R+S could avoid composite resection, reduce functional lesion and improve the QOL.
Adult ; Aged ; Carcinoma, Squamous Cell ; radiotherapy ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Quality of Life ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; radiotherapy ; surgery ; therapy ; Treatment Outcome

OBJECTIVETo explore a better approach to resect the advanced oropharyngeal carcinoma.

METHODSFrom 1995 to 2005, 17 patients underwent mandibular swing procedure for excision of advanced oropharyngeal carcinoma including: 13 tonsillar cancers, 2 soft palate carcinomas and 2 lingual root cancers. Surgical procedure was selected according to the lesion. All tumors were resected through the mandibular swing approach or its combined approaches. Immediate reconstruction of the surgical defect was done using tongue flap, pectoralis major myocutaneous flap, sternohyoid myofascial flap, temporalis myofascial flap and forehead flap, respectively. After surgical resection of the tumors, all patients received postoperative radiotherapy.

RESULTSAll patients' advanced oropharyngeal carcinoma were successfully resected as planned through the mandibular swing procedure or its combined procedures without severe complications. Functions of deglutition, respiration and speech were well restored. The 3- and 5-year survival rate was 54. 5% and 40%, respectively.

CONCLUSIONThe mandibular swing procedure and its combined approach is safe and effective in the surgical resection of the advanced oropharyngeal carcinoma, which can provide a good exposure for the oropharynx, supraglottic region, hypopharynx, the parapharyngeal space and the base of the skull.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Female ; Humans ; Male ; Mandible ; radiation effects ; surgery ; Middle Aged ; Neoplasm Staging ; Oropharyngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Postoperative Period ; Radiotherapy, Adjuvant ; Survival Analysis ; Tonsillar Neoplasms ; pathology ; radiotherapy ; surgery

PURPOSE: We tried to evaluate the role of conventional radiotherapy alone or with neoadjuvant chemotherapy in oropharyngeal cancerin terms of survival rates and to identify prognostic factors affecting survival by retrospective analysis. METHODS AND MATERIALS: Forty seven patients of oropharyngeal cancer were treated by conventional radiotherapy in our hospital from Nov. 1985 to Apr.1993. Of these. twenty six patients were treated by conventional radio therapy alone. and 21 patients with neoadjuvant chemotherapy of mostly two or more cycles of cisplatin and pepleomycin. The patient characteristics of radiotherapy alone group and neoadjuvant chemotherapy group were not different generally. Radiotherapy was performed by 6MV-LINAC and the total radiation doses of primary tumors were 54.0-79.2 Gy and cervical lymph nodes were 55.8-90.0 Gy with a fraction size of 1.8 or 2.0 Gy per day. The rangeof follow-up periods was 3-102 months and median was 20 months. The range of age was 33-79 years old and median was 58 years old. RESULTS: Overall 3-year actuarial survival rate (3YSR) of all patients was 39%. The 3YSRs of stage I (n=5), II (n=11), III (n=12) and IV (n=19) were 60, 55,33 and 32% respectively. The 3YSRs of T1+2, T3+4 and No, N+ were 55, 18% (p=0.005) and 43,36% (p>0.1), respectively. There was no difference in 3YSRs between radiotherapy alone group and neoadjuvant chemotherapy group (38 vs 43%, p>0.1). According to the original site of primary tumor, the 3YSRs of tonsil (n=32), base of tongue (n=8), soft palate or uvula(n=6) and pharyngeal wall (n=1) were 36,38,67 and 0%, respectively. The patients of soft palateor uvular cancer had longer survival than other primaries but the difference was not significant statistically (p>0.1). Of 32 patients of tonsillar cancer, 22 patients who had primary extension to adjacent tissue showed inferior survival rate to the ones who had not primary extension, but the difference was marginally significant (24 vs 60%, p=0.08). On Cox multivariate analysis in entire patients with variables of age. T stage. N stage. total duration of radiotherapy, the site of primary tumor and the use of neoadjuvant chemotherapy. only T stage was a significant prognostic factor affecting 3YSR. CONCLUSION: The difference of 3YASRs of conventional radiotherapy alone group and neoadjuvant chemotherapy group was not significant statistically. These treatments could be effective in oropharyngeal cancer of early stage, especially such as soft palate, uvular or tonsillar cancer which did not extend to adjacent tissue. But in order to improve the survival of patients of most advanced oropharyngeal caner, other altered fractionated radiotherapy such as hyperfractionation rather than conventional fractionation or multimodel approach combining radiotherapy and accessible surgery or concurrent chemotherapy might be beneficial.
Cisplatin ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Middle Aged ; Multivariate Analysis ; Oropharyngeal Neoplasms* ; Palate, Soft ; Palatine Tonsil ; Peplomycin ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tongue ; Tonsillar Neoplasms

PURPOSE: The purpose of this study is to analyze treatment outcome of radiotherapy (RT) in patients with stage III-IV tonsil cancer managed by surgery followed by postoperative RT (SRT) and definitive chemoradiotherapy (CRT), and to thereby evaluate the most feasible treatment modality. MATERIALS AND METHODS: Of 124 patients, 67 underwent CRT, and 57 underwent SRT. We compared survival and complication rates in both groups. RESULTS: The median follow-up time was 57 months (range, 19 to 255 months) for surviving patients. At five years, locoregional progression-free survival (LRPFS) and overall survival (OS) were 88% and 80%, respectively. No significant difference in LRPFS (p=0.491) and OS (p=0.177) was observed between CRT and SRT. In multivariate analysis, old age and higher T stage showed a significant association with poor LRPFS, PFS, and OS; higher N stage showed an association with poor PFS and a trend of poor LRPFS, while no association with OS was observed; treatment modality (CRT and SRT) showed no association with LRFPS, PFS, and OS. Grade 3 or higher mucositis was observed in 12 patients (21%) in the SRT group, and 25 patients (37%) in the CRT group. CONCLUSION: Definitive CRT and SRT have similar treatment outcomes for patients with stage III-IV tonsil cancer. Although acute complication rate appears to be higher in the CRT group, it should be noted that not all data on complications were included in this retrospective study. To determine the most feasible treatment modality, not only mucositis and xerostomia, but also emotional aspect and quality of life, should be considered.
Chemoradiotherapy ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucositis ; Multivariate Analysis ; Palatine Tonsil ; Quality of Life ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Tonsillar Neoplasms ; Treatment Outcome ; Xerostomia