Patients general condition limits routine use of chemotherapy with radiation, and many patients who are elderly, immunocompromised, or malnourished may not be candidates for adjuvant therapy. The current standard of treatment for advanced cancer of the tonsil is surgery followed by radiation. Composite resection of the tonsil and neck contents is followed by radiation. If extracapsular spread is present, chemotherapy has been shown to improve the results when used with postoperative radiation. The role of combined modality chemotherapy and radiation is under investigation but results in similar survival.
Surgical salvage is the next step for residual disease with or without brachytherapy.
Palliative neck dissection may be warranted in patients who have an unresectable primary tumor and a painful draining neck mass after treatment. Formal neck dissection is unnecessary in such patients, and removal of the majority of tumor bulk and draining sinuses often is sufficient to bring relief. Patients with a complete response may be observed, although neck dissection may be useful for persistent abnormalities and operable recurrences. Skin breakdown may occur secondary to extensive radiation and tumor growth. Skin breakdown may pose significant morbidity to the patient and results in pain, drainage, complex wound care, and carotid artery exposure.