Limitations of radiotherapy in the definitive treatment of squamous carcinoma of the tonsillar fossa.

Between 1970 and 1990, 104 patients with squamous cell carcinoma (SCC) of the tonsil were treated. The median age was 58 years and 80% of patients were males. Distribution among clinical stages was: stage I, 19 patients; stage II, 12 patients; stage III, 23 patients; and stage IV, 48 patients. More than 70% of patients had initial radiotherapy as definitive treatment irrespective of stage, reflecting the treatment philosophy over much of this period. The overall survival rate was 26% at 5 years, with survival being significantly affected by T stage, clinical stage and age. Clinical node status did not significantly affect survival rates. Good local control of T1N0 cancers was achieved with radiotherapy alone, but patients with more advanced cancers did poorly. We have now moved away from a non-selective policy and use initial surgery combined with postoperative radiotherapy in most patients, reserving radiotherapy alone for mainly early tonsil cancers.

Preliminary results of conservative treatment of early breast cancer with tumourectomy, axillary dissection and postoperative radiotherapy. A retrospective review of 107 patients.

A consecutive series of 107 patients with early breast cancer treated by tumourectomy, axillary dissection and postoperative radiotherapy was retrospectively reviewed. The average age at presentation was 48, range 30-79. Only 23.4% of women were post-menopausal. Average follow-up time was 48 months, range 19-94 months. Eight-three per cent had palpable lesions, the remaining 16.8% had needle localization. Ninety-four patients (88.7%) had lesions less than 2 cm in diameter clinically. One patient had a lesion greater than 3 cm in diameter clinically. Seventy-two per cent had invasive duct carcinoma. Twenty (18.9%) had invasive disease at the margins and fifteen were re-excised. Of the 20 patients who had invasive disease at the margins, three developed local recurrence. True loco-regional recurrence rate (i.e., loco-regional recurrence rate without distant metastasis) was 2.8%. All had level I and II axillary dissections and 26.4% were up-staged from clinical stage 1 to pathological stage II. Five patients died, three with recurrences and two with unrelated disease. Tumourectomy, axillary dissection and postoperative radiotherapy is an acceptable regimen for early carcinoma of the breast.

Radiotherapy in the treatment of carcinoma of the vocal cords: results of a 10-year experience.

A 10-year period of treatment at the Department of Radiotherapy of the Royal Prince Alfred Hospital was analysed retrospectively to assess the efficacy of "radical" irradiation in patients with early glottic cancer (Stages I and II). From June, 1964, to June, 1974, 120 patients were treated primarily with radiotherapy, which was followed by salvage laryngectomy for those with locally recurrent disease. Patient follow-up ranged from 0.5 to 12 years (mean, 6.2 years). The incidence of disease recurrence after radiotherapy was 13.7% for patients with Stage-I disease and 13.6% for patients with Stage-II disease. The five-year actuarial probability of local tumour control was 85% for patients with Stage-I disease. Ninety-one patients (77.8%) remain alive and well without disease recurrence, with an actuarial five-year survival probability for patients with stage-I disease of 93.8%. "Radical" irradiation for early glottic cancer can result in excellent survival rates with a small probability of local recurrence and few complications.