Faculty Bibliography

OBJECTIVE: Early stage squamous cell carcinoma of the tonsil is amenable to treatment by either surgery or radiation therapy as a single modality, with comparable rates of local control. Unfortunately, manifestation of the disease at an early stage is infrequent, and surgery or radiation alone is less successful in controlling advanced disease. This study was conducted to elucidate the optimal treatment plan for advanced stages of tonsillar carcinoma and to identify significant risk factors for development of recurrence or failure of local control. METHOD: We reviewed the UCLA experience with treatment of all stages of tonsillar carcinoma between 1970 and 1990. RESULTS: Actuarial local control rates were 70% for T1, 72% for T2, 50% for T3, and 0% for T4 at 5-year follow-up. Local control and overall survival rates were compared according to the type of treatment rendered for each stage. CONCLUSIONS: From our analysis we conclude that aggressive combination therapy with surgery and radiation yields significantly higher local control rates for stages 3 and 4 tonsillar carcinomas. The advantages and disadvantages of preoperative versus postoperative radiation therapy are discussed

The tumor microenvironment is determined by the interactions between host and tumor cells, a process in which cytokines play a major role. We have used retroviral vectors to insert and express cytokine genes in tumor cells so as to induce predictable changes in the host cells that infiltrate tumors. This frequently caused changes in tumor cell phenotype through autocrine/intracrine pathways. We reasoned that cytokine-induced alterations in tumor cell phenotype and/or in infiltrating host cells might alter the in vitro and in vivo cellular response to irradiation. In the present paper we document some of the effects of expression of interleukin-6 (IL-6) and IL-7 genes in tumor cells in this regard. The studies support the hypothesis that cytokines may play a role in determining both intrinsic tumor radioresponsiveness and the tumor microenvironment and in these ways may influence in vivo tumor irradiation responses. Possible cytokine gene-mediated approaches to radiotherapy cancer are discussed