Better to Toss the Tonsils First

Tonsillar carcinoma survival longer with surgery prior to radiation therapy

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Tonsils are located on either side of the back of throat. They are part of the immune system, but not critical for good health. Today, cancers found in the tonsils are the most common type of head and neck cancer.

A new study looked at how long tonsillar cancer patients lived following various types of treatment.

People who received radiation after their tonsils were removed lived longer than those who had radiation alone.

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Tonsillar cancers are increasing in the United States and abroad because they are associated with the human papillomavirus (HPV).

Head and neck cancers will be diagnosed in about 41,500 Americans this year. Of this number, 14,000 will be throat cancers.  

Michael A. Holliday, MD, an otolaryngology (ear, nose and throat) resident at Georgetown University Hospital, Washington, DC, directed research that used data from the Surveillance Epidemiology and End Results (SEER).

The goal of the study was to evaluate if survival was impacted by tonsillectomy (surgical removal of the tonsils) or other surgeries before radiation therapy compared to biopsy only. A biopsy gathers and tests tissue for cancer.

The standard of care for early-stage (stage I, II) tumors is either surgery or radiotherapy. Previous studies have found that both treatments offer about the same outcomes.

A total of 524 patients with stage I and II primary tonsil carcinoma were included in the study. These people had been diagnosed between 1988 and 2006 and had received radiation treatment.

Among those who had radiation after tonsillectomy, 83 percent were alive after five years. They had a disease-specific survival (disease was not cause of death) of 90 percent. This compared to an overall survival of 64 percent and a disease-specific survival of 76 percent for radiation therapy after biopsy alone.

“Our analysis revealed that radiation treatment after tonsillectomy is associated with better overall survival and disease-specific survival than is [radiation therapy] after biopsy alone,” the authors wrote.

This study was published April 18 in JAMA Otolaryngology Head Neck Surgery. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
April 18, 2013
Last Updated:
August 14, 2013