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Oropharynx 1Mar. 2006

Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme

Oropharyngeal Carcinoma



Carcinoma of oropharynx

•• WorkWork--up procedureup procedure

•• TNM stagingTNM staging

•• Primary treatmentPrimary treatment

•• FollowFollow--upup

•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease

•• ReferencesReferences



Clinical evaluation Evidence Option

l complete history of the diseasel weight and weight lossl performance status (Karnofsky / ECOG-WHO)l fiberoptic examination of H&N mucosal neck examinationl drawing of any lesions

Type CType CType CType CType CType C

Std.Std.Std.Std.Std.Std.



Endoscopic evaluation Evidence Option

l endoscopy under general anesthesia with biopsiesof any suspicious site

Type C Std.



Advanced clinical evaluation Evidence Option

l dental examination by oral surgeonl nutritional assessmentl others (if required)

Type CType CType C

Std.Std.Std.



Laboratory tests Evidence Option

l hemogram, coagulation tests, liver enzymes, kidney function (including a creatinine clearance)

l thyroid function: TSH (if radiotherapy scheduled)

Type C

Type C

Std.

Std.



Imaging Evidence Option

l Regional: CT scan (or MRI)1

l Metastatic work-up: chest X-ray, thoracic spiralCT scan

l Additional examination depending on previousfindings

l PET scan

Type CType C

Type C

Type 3

Std.Std.

Std.

Invest.1See guidelines for loco-regional imaging



Pathologic examination Evidence Option

Standards of the British Royal College ofPathologists (endorsed by EORTC)1

Type C Std.

1See pathology guidelines



Staging Evidence Option

• TNM classification (6th ed., 2002) • WHO International Classification of Diseases for

Oncology (ICD-O 9 or ICD-O 10)

Type C Type C

Std. Std.

For oropharynx and hypopharynx, T4 is divided into T4A (resectable) anT4B(unresectable) leading to the division of stage IV into stage IVA, stageIVB and stage IVC

Stage IVA T4aN0M0, T4aN1M0, T1N2M0, T2N2M0, T3N2M0, T4aN2MO

Stage IVB T4b any N M0, any T N3 M0

any T N3 M0

Stage IVC any T any N M1



TNM/AJCC 1997 StagingTNM/AJCC 1997 Staging

• Tx: primary tumor cannot be assessed• T0: no evidence of primary tumor• T1: Tumor limited to one subsite of hypopharynx and ≤ 2 cm• T2: Tumor invades more than one subsites of

hypopharynx or an adjacent site, or > 2cm and ≤ 4 cm without fixation of hemilarynx

• T3: > 4 cm or with fixation of hemilarynx• T4a invades thyroid/cricoid cartilage, hyoid bone, thyroid gland,

esophagus or central compartment soft tissue*• T4b invades prevertebral fascia, encases carotid artery, or invades

mediastinal structures

* Includes prelaryngeal strap muscles and subcutaneous fat




• N0: no regional node metastasis• Nx: regional nodes cannot be assessed• N1: single ipsilateral node, ≤ 3 cm• N2a: single ipsilateral node, > 3 cm and ≤ 6 cm• N2b: multiple ipsilateral nodes, ≤ 6 cm• N2c: controlateral or bilateral nodes, ≤ 6 cm• N3: node > 6 cm




•• Mx: Distant Mx: Distant metastasismetastasis cannotcannot bebe assessedassessed•• M0: No distant M0: No distant metastasismetastasis•• M1: Distant M1: Distant metastasismetastasis



Primary treatment: general strategy: base of tongue Evidence Option

l T1, N0, M0-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-surgery (T+N bilateral) ± RxTh1: young patient, infiltrative tumor, lateral tumor-bilateral ND ± RxTh (T±N)± brachyth (T)

l T1, N1,M0-RxTh (T+N bilateral)-surgery (T+N bilateral) ± RxTh1: young patient, infiltrative tumor, lateral tumor-bilateral ND ± RxTh (T±N) ± brachyth (T)

Type 3Type 3Type 3

Type 3

Type 3Type 3

Type 3

Std.Std.Std.

Std.

Std.Std.

Std.1 see guidelines for post-operative radiotherapy



Primary treatment: general strategy: base of tongue Evidence Option

l T2, N0-N1, M0-"moderately advanced" RxTh protocol (T+N)1 ± ND2

-surgery (T+N bilateral) ± RxTh3: young patient, infiltrative tumor, lateral tumor

l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N)1 + ND2

-surgery (T) + bilateral ND + RxTh3

-unilateral (bilateral) ND + RxTh (T+N):e.g.T1-T2,N3

Type 3Type 3

Type 3Type 3Type 3

Std.Std.

Std.Std.Std.

1see guidelines for RxTh regimen2see guidelines for post radiotherapy ND (slide 33)3see guidelines for post-operative radiotherapy



Primary treatment: general strategy: vallecula Evidence Option

l T1, N0, M0-surgery (T+N bilateral) ± RxTh1, if medically fitted-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-bilateral ND ± RxTh (T±N)± brachyth (T)

l T1, N1,M0-surgery (T+N bilateral) ± RxTh1, if medically fitted-RxTh (T+N bilateral)-bilateral ND ± RxTh (T±N) ± brachyth (T)

Type 3Type 3Type 3Type 3

Type 3Type 3Type 3

Std.Std.Std.Std.

Std.Std.Std.

1 see guidelines for post-operative radiotherapy



Primary treatment: general strategy: vallecula Evidence Option

l T2, N0-N1, M0-surgery (T+N bilateral) ± RxTh, if medically fitted-"moderately advanced" RxTh protocol" (T+N)1±ND2

l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N)1 + ND2

-surgery (T) + bilateral ND ± RxTh3

-unilateral (bilateral) ND + RxTh (T+N):e.g.T1-T2,N3

Type 3Type 3

Type 3Type 3Type 3

Std.Std.

Std.Std.Std.




Primary treatment: general strategy: tonsillar Fossa Evidence Option

l T1, N0, M0-surgery (T+N unilateral) ± RxTh1

-RxTh (T+N unilateral)-RxTh (T+N unilateral) ± brachyth (T)-unilateral ND ± RxTh (T±N) ± brachyth (T)

l T1, N1,M0-surgery (T+N unilateral) ± RxTh1

-RxTh (T+N unilateral)-unilateral ND ± RxTh (T±N) ± brachyth (T)


Type 3Type 3Type 3

Std.Std.Std.Std.

Std.Std.Std.




Primary treatment: general strategy: Tonsillar fossa Evidence Option

l T2, N0-N1, M0:-surgery (T+N unilateral) ± RxTh1, if medically fitted-"moderately advanced" RxTh protocol" (T+N unilateral)2±ND3

l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N) + ND3

-surgery (T) + unilateral (bilateral) ND ± RxTh1

-unilateral (bilateral) ND + RxTh (T+N): e.g. T1-T2, N3

Type 3Type 3

Type 3Type 3Type 3

Std.Std.

Std.Std.Std.

1see guidelines for post-operative radiotherapy2see guidelines for RxTh regimen3see guidelines for post radiotherapy ND (slide 33)



Primary treatment: general strategy: soft palate / uvula Evidence Option

l T1, N0, M0-surgery (T+N bilateral) ± RxTh1

-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-bilateral ND ± RxTh (T±N) ± brachyth (T)

l T1, N1,M0-surgery (T+N bilateral) ± RxTh1

-RxTh (T+N bilateral)-bilateral ND ± RxTh (T±N) ± brachyth (T)


Type 3Type 3Type 3

Std.Std.Std.Std.

Std.Std.Std.




Treatment: general strategy: soft palate / uvula Evidence Option

l T2, N0-N1, M0:-"moderately advanced" RxTh protocol"(T+N bilateral)1 ± ND2

-surgery (T+N bilateral) ± RxTh3

l T1-T4, ≥ N2a, M0-"locally advanced" RxTh protocol (T+N bilateral)1 + ND2

-surgery (T) + bilateral ND ± RxTh3


Type 3Type 3

Type 3Type 3Type 3

Std.Ind.

Std.Ind.Ind.




Primary treatment: general strategy: posterior pharyngeal wall Evidence Option

l T1, N0, M0-surgery (T+N bilateral) + RxTh1

-RxTh (T+N bilateral)l T1, N1,M0

-surgery (T+N bilateral) + RxTh1

-RxTh (T+N bilateral) ± ND2

Type 3Type 3

Type 3Type 3

Std.Std.

Std.Std.

1 see guidelines for post-operative radiotherapy 2 see guidelines for post radiotherapy ND (slide 33)



Treatment: general strategy: posterior pharyngeal wall Evidence Option

l T2, N0-N1, M0:-"moderately advanced" RxTh protocol" (T+N bilateral)1 ± ND2

-surgery (T+N bilateral) + RxTh3

l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N bilateral) + ND2

-surgery (T) + bilateral ND + RxTh3


Type 3Type 3

Type 3Type 3Type 3

Std.Std.

Std.Std.Std.




Primary treatment: surgical procedure of the “T” site:base of tongue

Evidence Option

l T1: - partial basiglossectomy by mandibular osteotomy- endoscopic microexcision by oral approach

only for small, well limited and well exposedtumor

l T2-T4: - partial vs subtotal basiglossectomy bymandibular ostetomy extended to upon tumor extension1

- Lateral pharyngectomy- Glossectomy (mobile tongue)- Laryngectomy

1 when the whole base of tongue need to be removed total laryngectomy should be considered in most cases for functional reasons

Type 3Type 3

Type 3

Std.Indiv.

Std.



Primary treatment: surgical procedure of the “T” site:Vallecula

Evidence Option

l T1: - extended supraglottic laryngectomy- endoscopic laser microexcision only for smallwell limited and well exposed tumor

l T2: - extended supraglottic laryngectomy- total laryngectomy: - for patient non suitable

for partial laryngectomy for medical reasons- when large resction of base of tongue is

requiredl T3-T4: - total laryngectomy + basiglossectomy

Type 3Type 3

Type 3Type 3

Type 3

Type 3

Std.Indiv.

Std.Std.

Std.

Std.



Primary treatment: surgical procedure of the “T” site:Tonsila fossa

Evidence Option

l T1: - partial pharyngectomy by oral approach(tonsillectomy, extended tonsillectomy)

l T2-T4: - partial pharyngectomy by oral approach (for veryselected T2)

- partial pharyngectomy by mandibular osteotomyextended to ( upon tumor extension)1. Soft palate2. Basiglossectoly3. Glossectomy4. Rhino-pharyngectomy

Type 3

Type 3

Type 3

Std.

Indiv.

Std.



Primary treatment: surgical procedure of the “T” site:Soft palate-uvula

Evidence Option

l T1: - local excision by oral approachl T2-T4: - partial pharyngectomy by oral approach (for very

selected T2) - partial pharyngectomy by mandibular osteotomy extended to ( upon tumor extension)

1. Soft palate2. Basiglossectoly3. Glossectomy4. Rhino-pharyngectomy

Type 3Type 3

Type 3

Std.Indiv.

Std.



Primary treatment: surgical procedure of the “T” site:Posterior pharyngeal wall

Evidence Option

l T1: - partial pharyngectomy by oral approach- laser microexcision

l T2: - oral approach: very selected T2- pharyngectomy by mandibulotomy

l T3-T4: - total pharyngectomy + total laryngectomy(in most cases)

Type 3Type 3Type 3Type 3Type 3

Std.Indiv.Indiv.Std.Std.



StdStd..StdStd..

InvestInvest..

Type CType CType CType CType 3Type 3

•• N site: N site: unilateralunilateral or or bilateralbilateral ND ND accordingaccording to Tto Tlocalisationlocalisation

––N0: N0: selectiveselective ND (IIND (II--IV or IIV or I--IV)IV)11

–– N1N1--N3: radical N3: radical modifiedmodified / radical ND / / radical ND / extendedextended RNDRND–– SentinelSentinel nodenode biopsybiopsy

11See See clinicalclinical targettarget volume for the volume for the nodesnodes ((slideslide 32)32)

Option Option EvidenceEvidencePrimaryPrimary treatmenttreatment: : surgicalsurgical procedureprocedure of the «of the « NN » site» site



Primary treatment: RxTh regimen Evidence Option

l Target volumesT: CTV = GTV + 1.5-0.5 cm marginN: see table on node levels according to T site

l Technique-conformal radiotherapy-IMRT radiotherapy

l Dose / fractionation / treatment timel Early stage:1

-prophylactic dose: 50 Gy,-therapeutic dose: 66-70 Gy, 2 Gy daily

l “moderately advanced"2 / "locally advanced"3 stage-on protocol: GORTEC 99-02 / IMCL CP02-9815-off protocol: moderately accelerated regimen

(concomitant boost)l post-operative RxTh

-dose: 60-64 Gy, 2 Gy daily4

Type 3Type 3

Type CType C

-Type 1

Type 2

Std.Invest.

Std.Std.

Invest.Std.

Std.1T1 N0-N12T2 N0-N13any T N2a-N34See guidelines for post-operative radiotherapy



Target Volumes: Target Volumes: oropharynxoropharynxLevel of evidence : type 3 / option : standardLevel of evidence : type 3 / option : standard

Stage Ipsilateral neck Controlateral neck

N0-N1 (Ib1)-II-III-IV + RP for post. II-III-IV + RP for post. pharyngeal wall tumor pharyngeal wall tumor

N2a-N2b Ib-II-III-IV-V +RP II-III-IV + RP for post. pharyngeal wall tumor

N2c According to N stage on According to N stage oneach side of the neck each side of the neck

N3 I-II-III-IV-V +RP ± adjacent II-III-IV + RP for post. structures according to clinical pharyngeal wall tumor

and radiological data

1Ib only if extension to oral cavity



StdStd..Type 3Type 3•• PlannedPlanned ND (SND, RMND, RND or ND (SND, RMND, RND or extendedextended ND) 2ND) 2--3 3 monthsmonths afterafter completioncompletion ofof RxThRxTh in patients in patients withwith aacontrolledcontrolled primaryprimary site site andand in case of in case of residualresidual or or suspected suspected

residualresidual, , resectableresectable N N diseasedisease irrespectiveirrespective ofof thethe initial N initial N stagestage

OptionOptionEvidenceEvidencePrimary treatment: neck dissection following a primary radiotherapy



Follow-up Evidence Option

l Clinical examination-fiberoptic examination and neck palpation every 2 months (first 2 years), every 6 months (3rd-5th year), then every year (> 5 years)-dental examination every 6 months

l Imaging-chest X-ray every year

l Laboratory tests-thyroid function (TSH) every year if radiotherapy delivered

l Evolution of late toxicity (EORTC/RTOG) scale

Type C

Type C

Type C

Type C

Type C

Std.

Std.

Std.

Std.

Std.



Salvage treatment for recurrent disease: general principle

Treatment will depend on:l Site and extension (rTNM stage)l Previous treatment(s)l Performance statusl Patient wishes



Salvage treatment for recurrent disease Evidence Option

l anyT-N0-M0-surgery ± RxTh1

-RxTh1 / brachyth (T < 3 cm)-chemotherapy

l T0-anyN-M0-ND ± RxTh1

-RxTh1

-chemotherapyl AnyT-anyN-M0

-surgery ± RxTh1

-chemotherapy-best supportive care

l Metastasis-chemotherapy-best supportive care

Type CType CType C

Type CType CType C

Type CType CType C

Type CType C

Std.Indiv.Indiv.

Std.Std.

Indiv.

Std.Indiv.Indiv.

Std.Std.

1depending on previous radiotherapy ; see guidelines for post-operative radiotherapy



ReferencesReferences• AJCC Cancer StagingManual fifth edition. Lippincott Williams & Wilkins, Philadelphia, 1997• Amdur RJ, Mendenhall WM, Parsons JT, Isaacs JH Jr, Million RR, Cassisi NJ. Carcinoma of the soft palate treated with irradiation:

analysis of results and complications. Radiother Oncol. 1987 Jul;9(3):185-94.• Bataini JP, Asselain B, Jaulerry C, Brunin F, Bernier J, Pontvert D, Lave C. A multivariate primary tumour control analysis

in 465 patients treated by radical radiotherapy for cancer of the tonsillar region: clinical and treatment parameters as prognostic factors. Radiother Oncol 1989;14:265-77

• Calais G, Goga D, Chauvet B, Carand G, Beutter P, Le Floch O. Carcinoma of the soft palate and uvula. An analysis of the results and the reasons for failures. A study of 76 cases. Rev Stomatol Chir Maxillofac 1988;89:306-10

• Calais G, Reynaud-Bougnoux A, Bougnoux P, Le Floch O. Squamous cell carcinoma of the base of the tongue: results of treatment in 115 cases. Br J Radiol 1989;62:849-53

• Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Bertrand P. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stageoropharynx carcinoma. J Natl Cancer Inst 1999;91:2081-6

• Cooper JS, Farnan NC, Asbell SO, Rotman M, Marcial V, Fu KK, McKenna WG, Emami B. Recursive partitioninganalysis of 2105 patients treated in Radiation Therapy Oncology Group studies of head and neck cancer. Cancer 1996;77:1905-11

• Crook J, Mazeron JJ, Marinello G, Martin M, Raynal M, Calitchi E, Faraldi M, Ganem G, Le Bourgeois JP, Pierquin B. Combined external irradiation and interstitial implantation for T1 and T2 epidermoid carcinomas of base of tongue: the Creteil experience (1971-1981). Int J Radiat Oncol Biol Phys 1988;15:105-14

• Dubray B, Mosseri V, Brunin F, Jaulerry C, Poncet P, Rodriguez J, Brugere J, Point D, Giraud P, Cosset JM. Anemia isassociated with lower local-regional control and survival after radiation therapy for head and neck cancer: a prospective study. Radiology 1996;201:553-8

• Esche BA, Haie CM, Gerbaulet AP, Eschwege F, Richard JM, Chassagne D. Interstitial and external radiotherapy in carcinoma of the soft palate and uvula. Int J Radiat Oncol Biol Phys 1988;15:619-25

• Evans JF, Shah JP. Epidermoid carcinoma of the palate. Am J Surg 1981;142:451-5• Fayos JV, Morales P. Radiation therapy of carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys 1983;9:139-44• Fijuth J, Mazeron JJ, Le Pechoux C, Piedbois P, Martin M, Haddad E, Calitchi E, Pierquin B, Le Bourgeois JP. Second

head and neck cancers following radiation therapy of T1 and T2 cancers of the oral cavity and oropharynx. Int J RadiatOncol Biol Phys 1992;24:59-64



ReferencesReferences• Foote RL, Olsen KD, Davis DL, Buskirk SJ, Stanley RJ, Kunselman SJ, Schaid DJ, DeSanto LW. Base of tongue

carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck 1993;15:300-7• Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys

1992;23:457-67• Galati LT, Myers EN, Johnson JT. Primary surgery as treatment for early squamous cell carcinoma of the tonsil. Head

Neck 2000;22:294-6• Gehanno P, Kebaili C, Guedon C, Moisy N, Sichel JY. Primary transmaxillary buccopharyngectomy and recovery

transmaxillary buccopharyngectomy in giant cancers of the tonsilar region. Apropos of 120 cases. Ann Otolaryngol ChirCervicofac 1987;104:329-36

• Gregoire V, Coche E, Cosnard G, Hamoir M, Reychler H. Selection and delineation of lymph node target volumes in headand neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgicalexperience. Radiother Oncol 2000;56:135-50

• Harrison LB, Zelefsky MJ, Pfister DG, Carper E, Raben A, Kraus DH, Strong EW, Rao A, Thaler H, Polyak T, Portenoy R. Detailed quality of life assessment in patients treated with primary radiotherapy for squamous cell cancer of the base of the tongue. Head Neck 1997;19:169-75

• Harrison LB, Zelefsky MJ, Armstrong JG, Carper E, Gaynor JJ, Sessions RB. Performance status after treatment for squamous cell cancer of the base of tongue--a comparison of primary radiation therapy versus primary surgery. Int J Radiat Oncol Biol Phys 1994;30:953-7

• Horiot JC, Le Fur R, N'Guyen T, Chenal C, Schraub S, Alfonsi S, Gardani G, Van Den Bogaert W, Danczak S, Bolla M, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 1992;25:231-41

• Housset M, Baillet F, Dessard-Diana B, Martin D, Miglianico L. A retrospective study of three treatment techniques for T1-T2 base of tongue lesions: surgery plus postoperative radiation, external radiation plus interstitial implantation andexternal radiation alone. Int J Radiat Oncol Biol Phys 1987;13:511-6

• Jaulerry C, Brunin F, Rodriguez J, Bataini JP, Brugere J. [Carcinomas of the posterior pharyngeal wall. Experience of the Institut Curie. Analysis of the results of radiotherapy]. Ann Otolaryngol Chir Cervicofac 1986;103:559-63



ReferencesReferences• Keus RB, Pontvert D, Brunin F, Jaulerry C, Bataini JP. Results of irradiation in squamous cell carcinoma of the soft palate

and uvula. Radiother Oncol 1988;11:311-7• Kraus DH, Vastola AP, Huvos AG, Spiro RH. Surgical management of squamous cell carcinoma of the base of the

tongue. Am J Surg 1993;166:384-8• Lee DJ, Cosmatos D, Marcial VA, Fu KK, Rotman M, Cooper JS, Ortiz HG, Beitler JJ, Abrams RA, Curran WJ, et al.

Results of an RTOG phase III trial (RTOG 85-27) comparing radiotherapy plus etanidazole with radiotherapy alone for locally advanced head and neck carcinomas. Int J Radiat Oncol Biol Phys. 1995:567-76.

• Lee WR, Mendenhall WM, Parsons JT, Million RR, Cassisi NJ, Stringer SP. Carcinoma of the tonsillar region: a multivariateanalysis of 243 patients treated with radical radiotherapy. Head Neck 1993;15:283-8

• Leemans CR, Engelbrecht WJ, Tiwari R, Deville WL, Karim AB, van der Waal I, Snow GB. Carcinoma of the soft palate andanterior tonsillar pillar. Laryngoscope 1994;104:1477-81

• Lusinchi A, Eskandari J, Son Y, Gerbaulet A, Haie C, Mamelle G, Eschwege F, Chassagne D. External irradiation plus curietherapyboost in 108 base of tongue carcinomas. Int J Radiat Oncol Biol Phys 1989;17:1191-7

• Mak-Kregar S, Hilgers FJ, Levendag PC, Manni JJ, Lubsen H, Roodenburg JL, van der Beek JM, van der Meij AG. A nationwidestudy of the epidemiology, treatment and survival of oropharyngeal carcinoma in The Netherlands. Eur Arch Otorhinolaryngol1995;252:133-8

• Marcial VA, Pajak TF, Kramer S, Davis LW, Stetz J, Laramore GE, Jacobs JR, Al-Sarraf M, Brady LW. Radiation TherapyOncology Group (RTOG) studies in head and neck cancer. Semin Oncol. 1988 Feb;15(1):39-60.

• Mazeron JJ, Langlois D, Glaubiger D, Huart J, Martin M, Raynal M, Calitchi E, Ganem G, Faraldi M, Feuilhade F, et al.Salvage irradiation of oropharyngeal cancers using iridium 192 wire implants: 5-year results of 70 cases. Int J Radiat Oncol Biol Phys1987;13:957-62

• Mazeron JJ, Belkacemi Y, Simon JM, Le Pechoux C, Martin M, Haddad E, Piedbois P, Calitchi E, Strunski W, Peynegre R, et al. Place of Iridium 192 implantation in definitive irradiation of faucial arch squamous cell carcinomas. Int J Radiat Oncol Biol Phys1993;27:251-7

• Mendenhall WM, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ. Radiation therapy for squamous cell carcinoma of the tonsillarregion: a preferred alternative to surgery? J Clin Oncol 2000;18:2219-25

• Mendenhall WM, Stringer SP, Amdur RJ, Hinerman RW, Moore-Higgs GJ, Cassisi NJ. Is radiation therapy a preferred alternative to surgery for squamous cell carcinoma of the base of tongue? J Clin Oncol 2000;18:35-42



ReferencesReferences• Meoz-Mendez RT, Fletcher GH, Guillamondegui OM, Peters LJ. Analysis of the results of irradiation in the treatment of squamous

cell carcinomas of the pharyngeal walls. Int J Radiat Oncol Biol Phys 1978;4:579-85• Moore GJ, Parsons JT, Mendenhall WM. Quality of life outcomes after primary radiotherapy for squamous cell carcinoma of the base

of tongue. Int J Radiat Oncol Biol Phys 1996;36:351-4• Perez CA, Patel MM, Chao KS, Simpson JR, Sessions D, Spector GJ, Haughey B, Lockett MA. Carcinoma of the tonsillar fossa:

prognostic factors and long-term therapy outcome. Int J Radiat Oncol Biol Phys 1998;42:1077-84• Pene F, Avedian V, Eschwege F, Barrett A, Schwaab G, Marandas P, Vandenbrouck C. A retrospective study of 131 cases of

carcinoma of the posterior pharyngeal wall. Cancer 1978;42:2490-3• Pernot M, Hoffstetter S, Malissard L, Luporsi E, Peiffert D, Aletti P, Marchal C, Kozminski P, Bey P. Value of the combination of

external radiotherapy and curietherapy in carcinoma of the velo-tonsillar region. Statistical study of a series of 361 patients. BullCancer Radiother 1996;83:40-6

• Pernot M, Hoffstetter S, Peiffert D, Aletti P, Lapeyre M, Marchal C, Luporsi E, Bey P, Nancy VL. Role of interstitial brachytherapyin oral and oropharyngeal carcinoma: reflection of a series of 1344 patients treated at the time of initial presentation. OtolaryngolHead Neck Surg 1996;115:519-26

• Peters LJ, Weber RS, Morrison WH, Byers RM, Garden AS, Goepfert H. Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy. Head Neck 1996 Nov-Dec;18:552-9

• Pinel J, Contencin P, Vilde F, Trotoux J. Treatment of carcinomas of the vallecula and epiglottis by supraglottal surgery. Indications and therapeutic results. Ann Otolaryngol Chir Cervicofac 1982;99:349-57

• Pinto LH, Canary PC, Araujo CM, Bacelar SC, Souhami L. Prospective randomized trial comparing hyperfractionated versus conventional radiotherapy in stages III and IV oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 1991;21:557-62

• Puthawala AA, Syed AM, Gates TC. Iridium-192 implants in the treatment of tonsillar region malignancies. Arch Otolaryngol1985;111:812-5

• Puthawala AA, Syed AM, Eads DL, Gillin L, Gates TC. Limited external beam and interstitial 192iridium irradiation in the treatmentof carcinoma of the base of the tongue: a ten year experience. Int J Radiat Oncol Biol Phys 1988;14:839-48



ReferencesReferences

• Remmler D, Medina JE, Byers RM, Meoz R, Pfalzgraf K. Treatment of choice for squamous carcinoma of the tonsillar fossa. Head Neck Surg 1985;7:206-11

• Spanos WJ Jr, Shukovsky LJ, Fletcher GH Time, dose, and tumor volume relationships in irradiation of squamous cell carcinomas of the base of the tongue. Cancer 1976;37:2591-9

• Spiro RH, Kelly J, Vega AL, Harrison LB, Strong EW. Squamous carcinoma of the posterior pharyngeal wall. Am J Surg1990;160:420-3

• START 2000: http:// www.cancereurope.-net/start/web/methodology.cfm• Trotti A. Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys 2000;47:1-12• Wang SJ, Wang MB, Yip H, Calcaterra TC. Combined radiotherapy with planned neck dissection for small head and neck cancers

with advanced cervical metastases. Laryngoscope 2000;110:1794-7• Weber RS, Gidley P, Morrison WH, Peters LJ, Hankins P, Wolf P, Guillamondegui O. Treatment selection for carcinoma of the base

of the tongue. Am J Surg 1990;160:415-9• Wong CS, Ang KK, Fletcher GH, Thames HD, Peters LJ, Byers RM, Oswald MJ.• Definitive radiotherapy for squamous cell carcinoma of the tonsillar fossa. Int J Radiat Oncol Biol Phys 1989;16:657-62• Zbaren P, Lehmann W. Frequency and sites of distant metastases in head and neck squamous cell carcinoma. An analysis of 101

cases at autopsy. Arch Otolaryngol Head Neck Surg 1987;113:762-4

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