ACR Appropriateness Criteria(R) ipsilateral radiation for squamous cell carcinoma of the tonsil

University of Florida, Gainesville, Florida. .
Head & Neck (Impact Factor: 2.64). 05/2012; 34(5):613-6. DOI: 10.1002/hed.21993
Source: PubMed


Controversy exists as to the criteria for selecting patients with carcinoma of the tonsil for treatment with ipsilateral radiotherapy (RT).
The American College of Radiology (ACR) Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of treatment procedures by the panel. In those instances where evidence is not definitive, expert opinion may be used to recommend treatment.
The ACR Expert Panel on Radiation Oncology - Head and Neck Cancer developed consensus recommendations for selecting patients with tonsillar carcinoma for ipsilateral RT.
Patients that are appropriate for ipsilateral RT have less than 1 cm of tumor invasion into the soft palate or base of tongue, and nodal stage of N0 to 1.

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    • "On the contrary, Perez et al. [7] reported that well lateralized tonsil cancer has a low incidence of contralateral neck metastasis. Generally, less than 1 cm of medial extension to the soft palate or to base of tongue (BOT) is accepted as well-lateralized tonsil cancer [8,9]. O'Sullivan et al. [9] reported a long-term result of ipsilateral RT in tonsil cancer, and the rate of opposite neck failure was very low, 3.5%. "
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    ABSTRACT: WE EVALUATED THE EFFECTIVENESS AND SAFETY OF IPSILATERAL RADIOTHERAPY FOR THE PATIENT WITH WELL LATERALIZED TONSIL CANCER: not cross midline and <1 cm of tumor invasion into the soft palate or base of tongue. From 2003 to 2011, twenty patients with well lateralized tonsil cancer underwent ipsilateral radiotherapy. Nineteen patients had T1-T2 tumors, and one patient had T3 tumor; twelve patients had N0-N2a disease and eight patients had N2b disease. Primary surgery followed by radiotherapy was performed in fourteen patients: four of these patients received chemotherapy. Four patients underwent induction chemotherapy followed by concurrent chemoradiotherapy (CCRT). The remaining two patients received induction chemotherapy followed by radiotherapy and definitive CCRT, respectively. No patient underwent radiotherapy alone. We analyzed the pattern of failure and complications. The median follow-up time was 64 months (range, 11 to 106 months) for surviving patients. One patient had local failure at tumor bed. There was no regional failure in contralateral neck, even in N2b disease. At five-year, local progression-free survival, distant metastasis-free survival, and progression-free survival rates were 95%, 100%, and 95%, respectively. One patient with treatment failure died, and the five-year overall survival rate was 95%. Radiation Therapy Oncology Group grade 2 xerostomia was found in one patient at least 6 months after the completion of radiotherapy. Ipsilateral radiotherapy is a reasonable treatment option for well lateralized tonsil cancer. Low rate of chronic xerostomia can be expected by sparing contralateral major salivary glands.
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