Recovery from postsurgical swallowing dysfunction in patients with oral cancer.

PURPOSE: The present study was focused on a comparison of postsurgical oropharyngeal swallowing efficiency and medical status indicators. PATIENTS AND METHODS: The swallowing function was assessed in 25 patients (18 males and 7 females) with oral cancer. The swallowing function was assessed preoperatively and 1, 6, and 12 months and in some cases more than 24 months after surgery. Assessment of the swallowing function consisted of videofluoroscopic evaluation (oropharyngeal swallow efficiency; OPSE) and details of the method of nutrition, diet level, nutritional condition, and occurrence of pneumonia. RESULTS: Postsurgically, OPSE did not recover to the preoperative level more than 12 months after surgery. Twenty-one patients (84%) had full oral intake and only 3 patients (12%) showed poorer nutritional conditions compared with the presurgery state. Aspiration pneumonia did not occur more than 12 months after surgery. CONCLUSIONS: The patients in the present study showed stable medical status and functional swallowing at the final evaluation despite insufficient recovery of OPSE revealed by videofluoroscopic evaluation.     

What patients consider important: Temporal variations by early and late stage oral,oropharyngeal and laryngeal subsites

Functional outcomes are of high priority to cancer patients and are relevant when considering treatment strategies. This study aimed to collate and analyse importance rankings of UW-QOL over time for patients treated with curative intent for primary head and neck squamous cell carcinoma between 2000 and 2010, and to compare early and late stage oral, oropharyngeal and laryngeal subsites. There were 1614 patients comprising oral cavity 47% (751), oropharyngeal 24% (382), laryngeal 20% (320) and other HNC locations 10% (161). Items of importance remained relatively stable within clinical groups but there were notable differences between groups. For patients with early oral tumours no domain was especially dominant, whereas for late oral tumours swallowing, chewing, speech and saliva were selected more often. Swallowing and saliva were more important in oropharyngeal tumours, as was taste with more advanced oropharyngeal tumours. Speech and activity were important for those with early laryngeal tumours, as were swallowing and speech for more advanced laryngeal tumours. Swallowing and saliva were more important in advanced tumours for all sites. This data confirms the priority patients place on swallowing, chewing, speech, and saliva, therefore curative treatments should optimise these functions wherever possible and provide access to post-treatment interventions as required.     

Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy

Tongue strength is reduced in patients treated with chemoradiotherapy for oral/oropharyngeal cancer. Tongue strengthening protocols have resulted in improved lingual strength and swallowing in healthy individuals, as well as in patients following a neurological event. However, no studies have examined the efficacy of tongue strengthening exercises on tongue strength, swallowing, and quality of life (QOL; Head and Neck Cancer Inventory) in patients treated with chemoradiotherapy. A randomized clinical trial examined the effects of a tongue strengthening programme paired with traditional exercises vs. traditional exercises alone. Dependent variables included tongue strength, swallowing, and QOL in a group of patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. Differences with regard to tongue strength and oropharyngeal swallow efficiency (OPSE) were not observed within or between groups. QOL in the eating and speech domains improved following treatment in both groups. However, the experimental group demonstrated greater impairment in QOL in the social disruption domain following treatment, whereas the control group demonstrated a slight improvement in functioning. Tongue strengthening did not yield a statistically significant improvement in either tongue strength or swallowing measures in this patient cohort. Patient compliance and treatment timing may be factors underlying these outcomes.     

口腔癌及口咽癌术后伴舌缺损患者吞咽功能的相关因素分析

目的　探讨口腔癌及口咽癌术后伴舌缺损患者吞咽功能与舌动度及舌压的相关性,筛选吞咽功能最佳预测指标。方法　选取2017年7月至2018年3月于中山大学附属口腔医院口腔颌面头颈肿瘤外科门诊复诊的口腔癌及口咽癌术后伴舌缺损患者36例,通过洼田饮水试验对其吞咽功能进行评级,应用舌运动范围法对其舌动度进行测量评分,同时利用爱荷华口腔行为仪测量其舌压。采用Spearman秩相关分析方法计算洼田饮水试验等级与舌动度评分及舌压之间的秩相关系数（rs）及相应的P值。结果　舌动度评分及舌压与洼田饮水试验等级的rs分别为-0.575和-0.613（均P＜0.05）;其中舌压与洼田饮水试验等级的rs值较舌动度评分的rs大。 结论　舌压与舌动度均可影响口腔癌及口咽癌术后伴舌缺损患者的吞咽功能,其中舌压是评估患者吞咽功能的最佳预测指标。     

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??Objective??To select the best predictor of swallowing functions by exploring the correlation between the swallowing function and tongue mobility and tongue pressure of the patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery. Methods??From July 2017 to March 2018??in Hospital of Stomatology??Sun Yat-sen University??thirty-six cases of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery were collected during return visits in the outpatient clinics of our hospital. The swallowing functions were graded by their water swallowing test??WST??results. The tongue mobility scores were evaluated by using the lingual range of motion??LROM??method??while the tongue pressure was measured by using the Iowa oral performance instrument??IOPI??. Spearman rank correlation analysis was applied to calculate the rank correlation coefficient??rs?? between the tongue mobility scores or tongue pressure and WST results??and the corresponding P value. Results??The rs value between WST results and tongue mobility scores or tongue pressure was -0.575 and -0.613 respectively??P??0.05??. The rs value of tongue pressure was larger than that of tongue mobility scores. Conclusion??Both the tongue mobility scores and tongue pressure have a great impact on the swallowing functions of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery??and tongue pressure is the best predictor.     

Outcome of salvage procedures for recurrent oral and oropharyngeal cancer

Despite advances in the primary treatment of oral and oropharyngeal cancer, many patients develop local or regional recurrence, or both, and when radiotherapy has already been used, operation provides the best chance of salvage for these patients. We have looked at the outcomes of salvage procedures in a single unit, including improved survival, morbidity, and treatment-related quality of life. Patients treated with salvage procedures were identified from a prospectively-completed database. Overall and disease-free survival were analysed using Kaplan–Meier curves and logrank tests. Functional, social, and emotional outcomes were assessed using the University of Washington Quality of Life Questionnaires. Twenty-nine patients were identified, of whom 24 had free flap reconstructions, and their estimated mean overall survival was 25 months (95% CI 20.4 to 29.2). Disease-free survival was significantly worse in patients with stage IV recurrences or in whom resection margins were close or invaded. Permanent gastrostomy was required in 15/29 patients, and four/29 needed a permanent tracheostomy. Answers to questionnaires showed that a large proportion of patients had considerable problems with speech, chewing, swallowing, and appearance. The decision on whether to treat recurrent head and neck cancer is a balance between improving survival and poor functional outcomes. The extent of disease and whether clear surgical margins can be achieved should be considered when treatment is recommended.     

Epidemiology and survival outcomes of lip,oral cavity,and oropharyngeal squamous cell carcinoma in a southeast Brazilian population

Background Lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) represent a major health problem in the global scenario. In South America, the highest incidence rates are seen in Brazil. Therefore, the epidemiological and clinical profile and survival outcomes of lip, oral cavity, and oropharyngeal SCC was studied in São Paulo State, Brazil.Material and Methods The clinicopathological data of 12,099 patients with lip, oral cavity, and oropharyngeal SCC were obtained from hospital cancer registries of the Fundação Oncocentro de São Paulo, Brazil (2010–2015). Survival rates and other analyses were performed using SPSS software.Results A clear male predominance was observed, particularly for patients with oropharyngeal SCC (88.3%). The average age of patients was higher for lip cases (65 ± 13.5 years) compared to other sites. The schooling level was low for most patients, especially in lip cases (87.9%). Most of the patients with oral cavity (71.8%) and oropharyngeal (86.3%) SCC had advanced-stage (III–IV) disease. However, the majority of lip cases (83.3%) were at an early stage (I–II). Surgical excision was the main treatment for lip (72%) and oral cavity SCC (23.5%), and chemoradiotherapy was the main treatment for oropharyngeal SCC (40.2%). The 5-year overall survival (OS) for patients with lip, oral cavity, and oropharyngeal SCC were 66.3, 30.9, and 22.6%, respectively. Multivariate analysis revealed that the determinants of OS were different for lip, oral cavity, and oropharyngeal SCC, except for those at the clinical stage, which was an independent predictor for all sites.Conclusions OS-independent determinants varied according to the affected site. Oral cavity and oropharyngeal SCC presented worse survival rates than those for lip SCC. Key words:Squamous cell carcinoma of head and neck, lip neoplasms, mouth neoplasms, oropharyngeal neoplasms, survival analysis.     

Assessment of surgical outcomes and oncological safety for submental artery perforator flap reconstruction after ablation of oral cancer

The submental artery perforator flap (SAPF) has been a new option for the intraoral reconstruction of oral squamous cell carcinoma (OSCC) patients in recent years, but its surgical outcomes have not been well assessed. We compared the surgical outcomes and oncological safety of SAPF reconstruction for medium-sized soft-tissue defects after the ablation of primary oral cancer with traditional submental island flaps (SIF) and anterolateral thigh perforator flaps (ALTPF). Fifty-one SAPFs, 30 SIF, and 74 ALTPF were reviewed for the intraoral medium-sized reconstructions after the ablation of oral cancer from our institutional clinical oncological databases. We performed comparative assessments on the variables of surgical outcome and oncological safety among the 3 cohorts. A Kaplan-Meier estimate of survival for each flap was calculated. Operating time was significantly reduced in the SIF and SAPF groups than ALTPF (p = 0.021 and 0.014, respectively). Flap thickness of SAPF was the significantly thinnest (mean 0.5 cm) among three groups. The common complications of donor site for both SAPF and SIF group were incision dehiscence and orocutaneous fistula. There was no significant difference in disease-free survival (DFS) among the 3 groups. However, several OSCC patients with the SIF reconstruction were found to have recurrences with a metastatic lymph node under the flap after the first operation. SAPF could be a versatile choice of the intraoral reconstruction for the medium-sized soft-tissue defects after the ablation of oral cancer.     

Pectoralis major myocutaneous flap for hypopharyngeal reconstruction: long-term results

Surgical treatment of hypopharyngeal cancer is indicated in advanced stages and recurrent/persistent disease after conservative regimens. As of today, no criterion standard treatment is applicable to all cases. Comparing functional results, complication rates and feasibility of different techniques proposed (free flaps, gastric pull-up, etc), and poor outcome in disease-free survival and in overall survival are more related to the tumor stage rather than the reconstruction technique. The authors discuss reconstructive surgery performed in 52 patients using a pectoralis major myocutaneous flap, according to a technique proposed by Spriano et al in 2001, after total circular partial/total hypopharyngectomy and total laryngectomy from January 1993 to 2008. Primary surgical treatment was performed in 38 patients. Surgery after radiotherapy/chemotherapy failure was performed in 8 patients. Surgery after chemotherapy was performed in 6 patients. Postoperative radiation treatment was administered in 35 patients. Two patients did not receive complementary radiotherapy: 1 patient died perioperatively and 1 had previous radiation treatment in 2002 for oropharyngeal cancer. Follow-up period ranged from a minimum of 7 months to a maximum of 15 years. Overall survival was 19.6%. To date, disease-free survival is 9 (17.3%) of 52 patients. Long-term follow-up shows that late complications are low or absent. For this reason, we consider this procedure to be time-sparing and safe, especially in this category of patients commonly affected by malnutrition and other long-term diseases.     

面动脉瓣修复口咽癌术后缺损

目的探讨面动脉瓣修复口咽癌术后缺损的效果及临床应用。 方法选择2008年5月至2014年1月中山大学孙逸仙纪念医院口腔颌面外科收治的口咽癌患者33例,行肿瘤扩大切除术同期采用顺行或逆行面动脉瓣修复组织缺损。 结果33例面动脉瓣中,逆行性皮瓣11例全部成活,而顺行性皮瓣成活18例、部分坏死2例、完全坏死2例。皮瓣成活病例伤口愈合良好,患者术后语音和吞咽功能得到恢复。 结论应用面动脉岛状肌皮瓣修复口咽癌切除术后缺损,制取技术简单,皮瓣血供明确,皮瓣成活率高,瘢痕较为隐蔽,是修复口咽癌切除术后缺损的理想皮瓣。     

Limited mouth opening after primary therapy of head and neck cancer

Objectives

Patients after surgery and radiation/chemoradiation for treatment of head and neck cancer often suffer from oral complications. These problems may be caused by surgery and radiation. Patients complain, for example, of swallowing problems and limited mouth opening (trismus).

Methods

The maximal interincisal mouth opening (MIO) was measured in patients treated with surgery and radiation/chemoradiation for head and neck cancer at the Department of Otorhinolaryngology at the University of Rostock. These patients also completed a 20-item questionnaire concerning nutritional, sensual, and speech disorders and pain.

Results

One hundred one patients (16 female and 85 male) returned the questionnaire and were included in the study. About 50% of the patients had a limited mouth opening (<36 mm); patients with oropharyngeal cancer had a significant higher risk for trismus (p?=?.024) than patients with other head and neck cancers, especially compared to patients with laryngeal cancer (p?=?.013). The questionnaire showed that especially patients with oral cancer report about problems with opening the mouth (73%), eating (65%), drinking (73%), xerostomia (92%), speech disorders (68%), and voice (62%). Patients with laryngeal cancer only reported about problems with xerostomia (62%), speech (83%), and voice (90%), similar to patients with pharyngeal cancer.

Conclusions

About half of the patients who underwent primary treatment for oral and oropharyngeal cancer developed trismus and reported about problems with opening the mouth, eating, drinking, dry mouth, voice, and speech. Trismus has a negative impact on quality of life and should be a focus in the postoperative management of patients with oral and oropharyngeal cancer, and, if diagnosed, special treatment should be initialized.     

Total glossectomy with preservation of the larynx: oncological and functional results

Our aim was to analyse the overall and disease-free survival (DFS), time to recovery of oral feeding, and morbidity, in a consecutive series of patients who had total glossectomy with preservation of the larynx for advanced cancer of the tongue at the European institute of Oncology (Milan). From June 2002 to April 2011, 37 patients who were treated for advanced cancer of the tongue had total glossectomy, bilateral neck dissection, and preservation of the larynx. Various flaps were used for reconstruction. Overall and disease-free survival were assessed from the day of operation to the latest outpatient examination. Postoperative morbidity and rehabilitation of feeding were also assessed. Six patients had major complications, four of whom had a second operation for necrosis of the flap. Actuarial five-year overall survival (OS) and disease-free survival were 54% and 47%. Twenty-four patients (65%) were operated on as their first treatment, and had 79% five-year overall survival and 61% 5-year disease-free survival. Twenty-six patients were eventually able to feed orally postoperatively. Although this retrospective study include a limited number of patients, the results support the validity of total glossectomy as a safe procedure for advanced cancer of the tongue. Pretreated patient were previously treated with surgery, radiotherapy or chemoradiotherapy with curative purposes. Nevertheless, the long period required for recovery of oral feeding indicates that total glossectomy should be reserved for highly motivated patients.     

Clinical outcomes and prognostic factor analysis after salvage surgery for recurrent squamous cell carcinoma of the oral cavity

The purpose of this study was to analyze the oncological outcomes and predictive factors for successful curative salvage surgery after recurrent oral cavity squamous cell carcinoma. A retrospective study was conducted involving 73 patients who received surgery-based salvage treatment. The pattern of failure for primary treatment was local failure in 29 patients, regional failure in 29 patients, and loco-regional failure in 15 patients. The 5-year overall, loco-regional failure-free, and disease-free survival rates were 54.8%, 58.9% and 49.3%, respectively. Patients with an advanced initial N stage, previous treatment with combined modality therapy, loco-regional recurrence, advanced recurrent T stage, a disease-free survival of less than 8 months prior to salvage, and recurrence in a previously treated field had a significantly worse prognosis. Given the potential surgical morbidity, salvage surgery should be undertaken after careful consultation with patients who have factors for a poor prognosis.     

3种方法修复口腔及口咽癌术后缺损1年后生存质量分析

目的：分析3种修复方式(拉拢缝合、颏下岛状皮瓣、前臂皮瓣)修复口腔及口咽癌患者术后缺损1年后的生存质量及相关影响因素。方法对 2012年1月—2012年10月在中山大学孙逸仙纪念医院口腔颌面外科行口腔及口咽癌术后1年的47例患者进行问卷调查。采用华盛顿大学生存质量问卷第4版及欧洲癌症研究与治疗组织生存质量问卷第3版、头颈问卷第1版。将伤口直接缝合、颏下岛状瓣、前臂皮瓣修复口腔及口咽癌术后缺损分为3组后,分析不同修复方式对患者术后1年生存质量的影响。采用SPSS 20.0软件包对数据进行统计学分析。结果47例患者完成相关问卷。前臂皮瓣组在吞咽、咀嚼、语言和UW-QOL整体项中显著优于直接拉拢缝合组（P<0.05）,在UW-QOL问卷中的总分也好于后者（P<0.05）,与颏下瓣组相比,2组患者的总体生存质量无显著差异（P>0.05）;颏下瓣组在咀嚼、语言和食欲丧失项中显著好于直接拉拢缝合组（P<0.05）。结论口腔及口咽癌术后1年患者中,吞咽、语言和咀嚼成为近期患者生存质量的主要方面,术后应加强对患者进行语言和吞咽等训练。术中同期对口腔及口咽癌进行皮瓣修复,可以显著提高患者的生存质量。     

Current thinking on the management of abnormal retropharyngeal nodes in patients with oral,oropharyngeal, and nasopharyngeal squamous cell carcinoma: a structured review

The management of enlarged retropharyngeal lymph nodes (RLN) in patients with confirmed oral, oropharyngeal, or nasopharyngeal squamous cell carcinoma (SCC) has prognostic relevance and is a challenge for the clinical teams. There is, however, no consensus regarding their clinical management or radiographic evaluation. The aim of this review therefore was to present the current thinking on management to help improve outcomes. We searched several online databases using the key terms “retropharyngeal node”, “oral cancer”, “head and neck cancer”, “oropharyngeal cancer”, “nasopharyngeal cancer”, “nasopharynx”, “oral cavity”, “oropharynx”, “TORS”, and “radiotherapy”. A total of 1024 papers were screened, of which 32 were eligible. There was no consensus about the management of RLN. There is a lack of randomised studies and a lack of consistency in the presentation of results. Management should be tailored in patients with nasopharyngeal carcinoma (NPC), and prophylactic irradiation is warranted as these nodes are at high risk of metastasis. In patients with non-NPC tumours, we prefer to resect them during primary operations when there is radiological uncertainty or evidence that they are affected, as the combination of radiological and histological outcomes will further our understanding. In both NPC and non-NPC tumours, sampling may also help to standardise the radiological criteria for the diagnosis of RLN by contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) CT.     

Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5–17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time.     

Relevance of positive margins in case of adjuvant therapy of oral cancer

Positive or clean surgical margins are of great prognostic interest in the surgical treatment of oral and oropharyngeal cancer with poor survival of patients burdened with positive margins. The impact of postoperative treatment modalities on the survival of these patients is debated. The relevance of positive margins was investigated in three patient populations (a group treated by surgery only, a group with postoperative polychemotherapy, and a group with a multi-modality treatment comprising postoperative radiation with concurrent chemotherapy) which were compared retrospectively. Patients treated with adjuvant regimens following resection in healthy margins had a survival advantage as compared to the surgery only group possibly due to less local relapses and longer relapse latencies. Overall disease-free survival was better in the groups with adjuvant therapy irrespective of free or positive margins. Survival rates following positive surgical margins were worse in all three groups as compared to the respective subgroups with healthy margins. A second resection in patients with positive margins, executed in the group with postoperative radiation with concurrent chemotherapy, did not result in survival improvement. Therefore, radical resection at initial surgery in healthy and clear margins remains indispensable in multi-modality treatment strategies involving surgery. The combination of healthy margins and adjuvant treatment seems to be most favorable for patient survival.     

Second primary tumours in oropharyngeal squamous cell carcinoma

Improved diagnostic techniques and more effective treatment concepts have resulted in a growing number of patients with oropharyngeal cancer diagnosed with second primary tumours. In order to evaluate the relative number of patients with second primary tumours and to estimate the efficacy of diagnostic procedures, a retrospective evaluation of 981 patients with oropharyngeal cancer, who were treated during 20 years in one single medical centre, was performed. In total, 9.2% of the patients were affected by secondary cancer, 1.5% from tertiary cancer and 0.2% from quartary cancer. Of the multiple cancers, 27.8% occurred synchronously and 72.2% metachronously. If the index tumour was located at the oral floor or the pharynx, the risk of second primary tumours was enhanced; if the index tumour was located at the lips or the tongue, the risk was reduced. The 5-year survival of all examined patients was 34.1%; the survival of patients with multiple cancers was 62.3% at the diagnosis of the index tumour and dropped to 30.5% at the diagnosis of an additional malignancy. Of the second primary tumours, 23.2% were diagnosed by panendoscopy. We conclude that among patients with oropharyngeal cancer, the presence of second primary tumours always has to be considered and that panendoscopy is a valuable tool for their diagnosis.     

Psychological outcome of patients following treatment of oral cancer and its relation with functional status and coping mechanisms

BACKGROUND: Traditionally health-care providers have measured outcome of treatment of disease by focusing on tumour response and disease-free survival. However, it has become increasingly apparent that the behavioural and functional impact of treatment on the patient is important. This study investigates the psychological outcome and its relationship with functional status and coping mechanisms following treatment of oral cancer patients. MATERIAL AND METHODS: Sixty-eight patients were evaluated 6 months to 6 years after treatment (from October 1992 to October 1997) for oral cancer. The Hospital Anxiety and Depression Scale (HADS) was used for psychological evaluation, the University of Washington Quality of Life Questionnaire (UW-QOL) and The European Organisation for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) for evaluating the head and neck specific and general functional status, respectively. Finally, the "Mental Adjustment to Cancer Questionnaire" (MAC-Q) was used for evaluation of coping mechanisms. RESULTS: The incidence of anxiety and/or depression was 25% and the socio-demographic and medical characteristics showed poor correlation with the psychological outcome in this study. The results indicated that there was a strong association between psychological outcome and head and neck specific and general quality-of-life (QOL) domains, and style of coping. The p-value was less than 0.01 for most of the domains and items of functional status and the effective coping style. CONCLUSION: Deteriorated functional status and ineffective coping strategies are strongly associated with poor psychological outcome in patients with oral cancer.     

Treatment results and prognostic factors in oral tongue cancer: analysis of 80 patients

Treatment results and prognostic factors for 80 patients with oral tongue cancer admitted to Istanbul University Oncology Institute between 1987 and 2000 were retrospectively analysed. The patients were treated by surgery and postoperative or curative radiotherapy. Median age was 55 (22-93) out of which 41 patients (51%) were male and 39 (49%) were female. One patient (1%) had stage I disease, 28 patients (36%) stage II, 18 patients (23%) stage III and 32 patients (40%) stage IVA disease. Nineteen patients (24%) were medically inoperable or refused surgical treatment, so were treated with curative radiotherapy to a total dose of 70Gy (group A). The remaining 61 patients (76%) were treated with surgery and postoperative external beam radiotherapy (group B). The median follow-up time was 44 months. The 5-year overall and loco-regional disease-free survival rates were 42% and 46%, respectively. The 5-year overall survival rates were 16% in group A and 49% in group B (P=0.0002). The 5-year disease-specific survival rate was 23% in group A while in group B it was 49%; the difference was statistically significant (P=0.02). Combined treatment improves overall and disease-free survival in patients with stage II, III and IVA oral tongue cancer. In patients who are not candidates for surgery, the effect of radiotherapy may be increased with the use of brachytherapy.