Carcinoma of the tongue base treated by transoral laser microsurgery, part two: Persistent, recurrent and second primary tumors

OBJECTIVES: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tongue base. STUDY DESIGN: A two-center prospective case series analysis. METHODS: Twenty-five patients with persistent, recurrent, or second primary squamous cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. Four (16%) patients with persistent disease at the primary site were considered TX. Eleven (44%) patients with recurrent disease were pathologically staged rT1 3/11, rT2 2/11, rT3 4/11, T4 1/11, and TX 1/11. Ten (40%) patients with second primary tumors were staged pT1, 4/10; pT2, 3/10; pT3, 2/10; and pT4, 1/10. Eight (32%) patients underwent neck dissection. Three (12%) patients received adjuvant radiotherapy. Pre- and post-treatment organ function was assessed using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale. RESULTS: The mean follow-up period was 26 months. The 2-year Kaplan-Meier local control and locoregional control estimate was 69%. For those patients presenting with persistent/recurrent or second primary disease, the 2 year local control estimates were 75% and 68%, respectively. For all patients, the respective 2 and 5 year overall survival estimates were 54% and 26%. Two (8%) patients suffered postoperative hemorrhage. The average duration of hospitalization was 3.6 days. The median pretreatment and posttreatment FOSS stage was stage 2 and stage 3, respectively. CONCLUSIONS: Transoral laser surgery is a rational and effective treatment in appropriately selected patients with persistent, recurrent, or second primary tongue base cancer. The low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.     

Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue

OBJECTIVE: To determine the role of transoral laser microsurgery for base of tongue squamous cell carcinoma. DESIGN: Retrospective unicenter study of the oncologic and functional results of laser microsurgery of tongue base carcinoma performed between 1986 and 1997. SETTINGS: University hospital department. PATIENTS: We reviewed 48 previously untreated patients with base of tongue squamous cell carcinoma, who were treated with transoral laser microsurgery. Distribution of the T categories were T1, 2%; T2, 25%; T3, 15%; and T4, 58%; 94% belonged to the stages III and IVa. Selective neck dissection was performed in 43 patients; 23 patients underwent postoperative radiotherapy with or without simultaneous chemotherapy. MAIN OUTCOME MEASURES: Local control rate, recurrence-free and overall survival rates, mean performance status scale scores for normalcy of diet and understandability of speech. RESULTS: The Kaplan-Meier 5-year local control rate was 85%. There was no local recurrence in T1 and T2 lesions, but there was a 20% local recurrence rate in T3 and T4 tumors. Kaplan-Meier 5-year recurrence-free and overall survival rates were 73% and 52%, respectively. Mean performance status scale scores were 92% for normalcy of diet and 88% for understandability of speech. Twenty-one patients survived at least 5 years after treatment. They have a preserved larynx and live without tracheostoma or gastrostomy tube. CONCLUSIONS: Our concept of organ and function preserving laser microsurgery for selected patients with base of tongue cancer seems to be justified considering the achieved oncological and functional results. Final proof of the effectiveness of the new therapeutic concept presented herein requires well-designed prospective studies.     

Organ preserving transoral laser microsurgery for cancer of the hypopharynx

OBJECTIVE: To assess the feasibility of transoral laser microsurgery (TLM) in the treatment of hypopharyngeal cancer, with a special focus on piriform sinus carcinomas, and to report the oncologic and functional outcomes. STUDY DESIGN: Prospective case-series study at a single institute, an academic tertiary referral center. METHODS: A total of 172 patients with previously untreated squamous cell carcinoma of the hypopharynx were eligible for this study (1986-2003). The piriform sinus was the most common localization (n = 150). Patients with simultaneous second primaries, distant metastases, or N3 neck disease and cancers of the category pT4b were excluded. Fifteen percent of the patients had stages I and II (according to guidelines from the Union Internationale Contre le Cancer 2002/American Joint Commission on Cancer, 2002), and 85% had stages III and IVa. The median follow-up period was 45 months. All patients (n = 172) were treated by TLM, mainly by selective neck dissection (93%) and/or postoperative radiotherapy (52%). Overall survival, recurrence-free survival, organ preservation, and local control were analyzed as end points. Rate of tracheotomies, postoperative complications, and swallowing function (feeding tube dependency) were also analyzed. RESULTS:: Five-year Kaplan-Meier local control was 84% for pT1; 70% for pT2; 75% for pT3; and 57% for pT4a. Five-year Kaplan-Meier recurrence-free survival was 73% for stages I and II, 59% for stage III, and 47% for stage IVa. The whole group of 172 hypopharyngeal cancer patients was analyzed, with an additional special focus on the homogenous group of piriform sinus carcinomas (n = 150). CONCLUSIONS: Our data support the conclusion that TLM is a valid option to standard radical surgery or standard conservation treatment. Oncologic and functional results compare favorably, while morbidity and complication rates tend to be lower.     

Oncologic and functional results after transoral laser microsurgery of tongue base carcinoma

The objective of the study was to determine the oncological and functional results in patients after excision of tongue base carcinoma by transoral laser microsurgery. A retrospective unicenter study performed between 1986 and 2007. 82 patients with previously untreated squamous cell carcinoma of the tongue base (T1–4, N0–2, M0) underwent transoral laser surgery with curative intent. Stage distribution was as follows: stage I, 1 case (1 %): stage II, 6 cases (7 %): stage III, 14 cases (17 %): stage IV 61 cases (75 %). Main outcome measures are local control rate, overall survival, recurrence-free survival, complications, and feeding tube dependence. The results were Kaplan–Meier 5-year local control rate for all patients was 84 %. T-stage-related local control rate after 5 years was 94 % for stage I–II, 78 % for stage III and 81 % for stage IV. 5-year overall survival and recurrence-free survival were 59 and 69 %, respectively. UICC stage-related overall survival and recurrence-free survival were 70 and 86 % for stage I–II, 44 and 54 % for stage III and 58 and 69 % for stage IV. Postoperative bleeding at the primary tumor site occurred in 9 patients (11 %). Gastrostomy tubes remained in place permanently in 5 patients (6 %). Primary transoral laser microsurgery of tongue base carcinoma offers convincing oncological and functional results comparable to other treatment modalities, e.g., radio(chemo)therapy but has lower rates of morbidity.     

Treatment results for 84 patients with base of tongue cancer

CONCLUSIONS: For T2 tumors, surgery was indicated if functional preservation was possible. For T3/T4 tumors, the rate of primary disease control was not high and surgery frequently involved total laryngectomy. Points that surgeons must heed when performing such surgery were delineated. OBJECTIVES: Because tumors originating from the base of the tongue are rare, few large-scale studies of such tumors have been performed. We reviewed treatments and outcomes at our department to establish effective future therapeutic plans. PATIENTS AND METHODS: From 1971 to 2000, 84 patients with previously untreated and resectable squamous cell carcinoma of the base of the tongue were treated at the Head and Neck Department of the Cancer Institute Hospital, Tokyo. Treatment selection and results were investigated. RESULTS: The main treatment options were radiotherapy for primary lesions < or = T2 and surgery for primary lesions > or = T3. Overall disease-specific 5-year cumulative survival rate was 59.8%, but there was no significant difference in survival rate at each stage between the two treatments. Among patients who died of the primary disease, the area that was most difficult to control was the superior margin of the lateral wall of the oropharynx (n=7). The incidence of contralateral or retropharyngeal lymph node metastasis was low if tumors neither crossed the midline nor infiltrated the lateral wall. While total laryngectomy was performed on 48 patients, the larynx was operatively preserved in 5 T3 patients and one T4 patient.     

Treatment of squamous cell carcinoma of the tongue base: irradiation, surgery, or palliation?

OBJECTIVES: Squamous cell carcinoma of the tongue base has a poor prognosis, and treatment is accompanied by a number of major problems. In view of this, it is important to recognize which patients will benefit from treatment with curative intent and which treatment method to use. METHODS: One hundred sixty-five patients with squamous cell carcinoma of the tongue base were identified on our database. Eighty-two patients were treated by radical irradiation, and 41 by surgery. A further 42 patients were considered unsuitable for curative treatment. RESULTS: The 5-year cause-specific survival rate was 41% for those treated by irradiation, 58% for those treated by surgery, and 9% for untreated patients. There was no difference in the efficacy of treatment methods (p = .5362), but a highly significant difference was seen in survival rate between treated and untreated patients (p = .0028). The decision regarding administration of curative treatment was based on the extent of locoregional involvement at the primary site (p = .0139; odds ratio, 0.43) and in the neck (p = .0078; odds ratio, 0.23). No factors affected the decision to treat by irradiation or surgery. When the observed survival rate was calculated, there was no significant difference in 5-year survival rate between treated and untreated patients (p = .2762). Those with early (T1-2) disease at the primary site had an improved survival rate from 0.5 to 4 years compared with those who were untreated (T3-4; p = .0081; odds ratio, 2.2). In addition, those with early (T1-2) disease had a better survival rate than those with advanced cancers (p = .0139; odds ratio, 2.09). There was, however, no difference in survival rate at 5 years. Those with early disease compared with those with advanced disease were twice as likely to be alive at 2 years; however, all survival advantages had disappeared by 5 years. CONCLUSIONS: In terms of observed survival, treating tongue base squamous cell carcinoma that is locally advanced (T3-4) at presentation offers no survival advantage over palliation alone. Treating early disease (T1-2) doubles the survival rate for up to 4 years, but by 5 years this survival advantage is lost. The present study finds radiotherapy and surgery to be equivalent at controlling this disease.     

Results of transoral laser microsurgery in 102 patients with squamous cell carcinoma of the tonsil

The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13 % presented with stage I and II (UICC/AJCC 2002) tumors and 87 % with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95 %) and with (66 %) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan–Meier local and loco-regional control was 78 % for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan–Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59 % for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.     

Transoral laser microsurgery for advanced laryngeal cancer

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.     

Long-term survival outcome in transhyoid resection of base of tongue squamous cell carcinoma

BACKGROUND: The transhyoid approach for the resection of squamous cell carcinoma (SCC) of the base of the tongue continues to evolve and remains controversial. We previously reported that the functional outcome of this operation is superior to that of the traditional transmandibular approaches. OBJECTIVE: To report our long-term survival rates for T1, T2, and select T3 SCCs of the base of the tongue using the transhyoid approach. PATIENTS AND METHODS: Twenty-eight patients with SCC of the base of the tongue were treated using a transhyoid approach at the University of California, Los Angeles, Medical Center between 1981 and 1998. RESULTS: All 28 patients underwent simultaneous neck dissection, and 27 patients underwent postoperative radiation therapy. The majority of the patients had advanced stage III or IV SCC. Twenty-five of the 28 patients had clear margins in the final pathologic specimen. The overall 3- and 5-year patient survival rates were 88.5% and 80.0%, respectively. Tumor-specific 5-year survival rates were 80.0%, 84.6%, and 50.0% for T1, T2, and T3 tumors, respectively. Stage-specific 5-year survival rates were 60.0%, 100.0%, and 80.0% for stages II, III, and IV, respectively. CONCLUSIONS: The advantages of the transhyoid approach to SCC of the base of the tongue in conjunction with neck dissection and postoperative radiation therapy include excellent long-term patient survival, improved swallowing and speech function, outstanding tumor exposure, and minimal cosmetic deformity.     

Squamous-cell carcinoma of the tongue: treatment results and prognosis

OBJECTIVE: The aim of the study was to assess the results of curative treatment of patients with squamous cell carcinoma of the tongue and to evaluate survival and predictive factors of recurrence. PATIENTS AND METHODS: A series of 309 patients with squamous cell carcinoma of the tongue treated with curative intent was studied from January 1988 to December 1999. The percentage of oral tongue cancer was 82.2 and the percentage of cancer of base of the tongue was 17.8. Most patients underwent surgical procedure alone or combined with radiotherapy (92%). We performed 252 neck dissections. Bilateral dissections were performed for cancer of the apex linguae, cancer of the base of the tongue, for patients with N2c neck disease and whenever the primary tumor site crossed the median line. Twenty-five patients (8%) were treated with radiation therapy alone. Mean follow-up was 55 months. The functional results were assessed within a minimum of 10 months postoperative follow-up. RESULTS: In 45.2%, there was histological evidence of node invasion with 53.5% of extracapsular node spread in the neck specimens. Extracapsular node spread did not influence survival or recurrences. Occult cervical metastasis in an elective neck dissection in clinically negative necks was found in about 20% of patients with 47% of extracapsular node spread (41% for cancer of mobile tongue and 80% for those of base of the tongue). About 23% of patients with cancer of base of the tongue staged N0 had histological node invasion in controlateral neck nodes. The postoperative mortality rate was 0.9%. The rate of complications was 17%. The cancer recurred in 41.7% of all cases. Twelve percent of all patients had second primary cancers of the upper aerodigestive tract. The overall survival and non-recurrence rates at 2 and 5 years were higher in cancer of oral tongue than in cancer of base of the tongue. Survival rates were better when neck nodes were clinically or histologically negatives and in early-stage carcinomas. Non-recurrence rates were better when nodes were clinically or histologically negatives and when margins of exeresis were not involved. The functional results were better in oral tongue cancer than in base of the tongue cancer. DISCUSSION: Prognosis (survival and non-recurrence rates and functional results) of squamous cell carcinomas of oral tongue was better than prognosis of those of base of tongue. We recommend an aggressive surgical procedure even in patients with neck classed N0 (with reservations for T1 lesions with small depth of invasion): an ipsilateral supraomohyoid neck dissection for cancer of oral tongue and a bilateral supraomohyoid neck dissection for cancer of base of the tongue, cancer of oral tongue which crosses the median line of the oral cavity and cancer of the apex linguae. Postoperative radiotherapy must be performed when margins are positives and/or when nodes are involved with or without extracapsular spread.     

Organ preservation in T4a laryngeal cancer: is transoral laser microsurgery an option?

The main objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of T4a laryngeal cancer and to report the oncological and functional outcomes. This is a retrospective case-series study, held in a single-institute, academic tertiary referral center. Seventy-nine patients with previously untreated T4a glottic (n = 31, 39 %) or supraglottic laryngeal carcinoma (n = 48, 61 %) were included in this study. Five patients (6 %) were treated exclusively by TLM, 16 (20 %) had TLM and unilateral neck dissection, 27 (35 %) had TLM and bilateral neck dissection. Adjuvant (chemo)radiotherapy was additionally administered in 26 (33 %) cases following TLM and neck dissection, and in 5 (6 %) cases after TLM without neck dissection. The main outcome measures included organ preservation, local control, functional outcome, overall, recurrence-free, and disease-specific survival. The median follow-up period was 49 months, 5 year organ preservation rate and local control rate were 80.0 and 67.2 %, 5 year overall, recurrence-free and disease-specific survival were 55.8, 61.9 and 71.8 %. The 5 year overall survival rates were 62.5 % in pN0 cases and 57.2 % in cases with pN-positive neck disease. With respect to survival, these results are comparable to total laryngectomy, while being superior to primary (chemo)radiotherapy. TLM results in a low morbidity, rapid recovery and good function and can be a valid option for organ preserving surgery of pT4a glottic and supraglottic cancer.     

Role of surgery in limited (T1-2, N0-1) cancers of the oropharynx

Hypothesis: To define the role of surgical staging in limited (T1‐2, N0‐1) oropharyngeal squamous cell cancers. Study Design: Retrospective. Methods: Forty‐nine limited oropharyngeal squamous cell cancers of the tonsil, tongue base, or posterior pharyngeal wall‐treated surgically were identified. Results: Thirty‐five percent were cT1 and 65% were cT2 tumors although 58% were cN0 and 42% were cN1. Forty‐six patients underwent neck dissections. Surgical staging altered T‐stage in 26% (13/49), nodal status in 23% (11/46), and clinical staging in 40% (20/49) of patients. Among 35 disease‐free patients, 28% (4/20) of stage I/II patients received postoperative radiation and chemotherapy was avoided in 80% (12/15) of stage III patients. T1 tumors seemed to have better outcomes (P = .06). The 3 year disease‐free survival and 5 year overall survival was 85% and 83%, respectively. Conclusions: Surgical staging identifies patients in whom intensification of treatment with chemotherapy can be most appropriately applied, and enables de‐intensification of therapy in pathology confirmed stage I/II disease.     

Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery

Materials and methodsThe records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed.ResultsA total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC–). The mortality rates were 18.1% and 3.7% in the AC+ and AC– groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC– group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%.PurposeThis study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM).ConclusionAC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.     

Neck dissection prior to radiation therapy for squamous cell carcinoma of tongue base

BACKGROUND: Squamous cell carcinoma of the tongue base can be treated with comparable control and survival rates when neck dissection (ND) is performed before radiation therapy (RT). METHODS: Fourteen patients were treated between 1990 and 2000. Tumor stage on presentation was: T2, 6; T3, 4; T4, 4. Average radiation dose was 7,268 cGy. Follow-up ranged from 2 to 11 years (median, 50 months). Ten patients (71.4%) who presented with cervical metastases underwent neck dissection. All neck dissections were performed prior to RT. RESULTS: The initial local control rate was 85.7%. The 10-year survival rate was 62.8%. Patients tolerated their procedure well and were ready for RT within 2 to 4 weeks. CONCLUSIONS: Our preliminary data indicate that our treatment protocol results in control and survival rates which are comparable with other regimens. It is our impression that in contrast to patients undergoing ND after radiation, our patients tolerated their initial ND well and were better prepared for the second part of the treatment. Future studies will use quality-of-life research methods to study this aspect of the treatment protocol.     

Analysis of treatment results for base of tongue cancer

OBJECTIVE: The study reported the results of treatment for base of tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: This was a retrospective study of 262 patients with base of tongue cancer treated in the Departments of Otolaryngology-Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from July 1955 to January 1998. METHODS: The study population included previously untreated patients with biopsy-proven squamous cell carcinoma of the base of tongue who were treated with curative intent by one of five modalities and were all eligible for 5-year follow-up. The treatment modalities included local resection alone, composite resection alone, radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. RESULTS: The overall 5-year disease-specific survival (DSS) was 49.6% with death due to tumor in 50.4%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.526 (Kaplan-Meier) with a mean of 7.8 years and a median of 5.6 years. Patients with early disease had significantly improved DSS compared with patients with more advanced disease (stages I and II; TN stages T1N0, T2N0, and T2N1; and T stages T1 and T2.). Patients with N0 had better DSS than patients with positive lymph nodes (P =.010). The DSS for all stages by treatment modality included local resection (70.0%), composite resection (47.6%), radiation therapy (40.4%), local resection and radiation therapy (50.0%), and composite resection with radiation therapy (51.5%). Overall and within the stages there was no significant difference in either DSS or CDSS by treatment modality. Local-regional recurrence occurred in 26% of patients, and overall salvage was 10.5%. Patients with clear resection margins did better than patients with close or involved margins (DSS and CDSS). Patients treated with radiation therapy alone had improved capacity to swallow (P =.001), speak (P =.01), and work (P =.001) compared with patients treated with the other modalities. CONCLUSIONS: Cancer of the base of tongue is a lethal disease, and its treatment results in significant disability. No treatment produced a significantly improved survival advantage. Focus on improving local-regional control might improve overall survival. All treatment modalities were associated with major treatment-related complications. Radiation alone produced significantly improved post-treatment function and quality of life compared with the other modalities. Because of the recurrence rates at the primary and neck sites and the high rates of development of distant metastasis and second primary cancers, patients should be monitored for a minimum of at least 4 years.     

Functional outcomes after treatment of squamous cell carcinoma of the base of the tongue

OBJECTIVE: To compare functional outcome and quality of life after various treatments for squamous cell carcinoma of the base of the tongue. DESIGN: Retrospective survey using statistical comparison. SETTING: Academic medical center, institutional practice. PARTICIPANTS: Patients treated for squamous cell carcinoma of the base of the tongue between 1976 and 2000. Living patients 3 or more months after treatment were eligible. Questionnaire packets including validated site-specific quality-of-life instruments were mailed to 105 qualifying patients. Sixty-one patients participated, forming a volunteer sample. Patient responses were grouped according to treatment modality, operative vs nonoperative. MAIN OUTCOME MEASURES: The planned outcome was that nonoperative therapy would result in better function than operative treatment. RESULTS: Most comparisons indicated no statistical difference in outcome between operative and nonoperative groups. Significant differences (95% confidence interval) were calculated for age, interval since treatment, and T stage. Group comparisons of patient responses revealed significant differences only in xerostomia and days hospitalized. CONCLUSIONS: The tongue remains dysfunctional after both surgical and nonoperative treatment. Nonoperative treatment might more adversely affect saliva. Surgery is associated with a longer hospital stay.     

Local control of oropharyngeal carcinoma by irradiation alone

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation therapy at Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary from 1970 through 1993. Radiation therapy remains the treatment of choice for these lesions. Although the data from this review were not randomized, the accelerated hyperfractionated radiation therapy twice-daily program was shown to achieve significantly higher 5-year local tumor control rates and disease-specific survival rates than the conventional once-daily radiation therapy program (historical control). In patients with early tumors of the faucial tonsil (cancer stages T1 and T2), the 5-year actuarial local tumor control and disease-specific survival rates following the twice-daily radiation therapy program were 91% and 77%, respectively. In patients with advanced tumors (T3), the corresponding rates following twice-daily radiation therapy showed marked improvement and were 80% and 68%. While the treatment results for carcinoma of the base of the tongue generally were inferior to those for carcinoma of the faucial tonsil, they were still much better after the twice-daily program than after conventional once-daily irradiation. For patients with carcinoma of the base of the tongue, the local tumor control and disease-specific survival rates for T1 and T2 lesions were 85% and 76%, respectively. For T3 lesions, the corresponding rates were 54% and 53%. Extensive T4 tumors are better managed by combined surgery and postoperative irradiation. Residual metastatic nodal disease is managed by neck dissection.     

A randomized phase III trial of cisplatinum, methotrexate, cisplatinum + methotrexate, and cisplatinum + 5-fluoro-uracil in end-stage head and neck cancer

In a previous phase III trial of chemotherapy for patients with end-stage squamous cell carcinoma of the head and neck we have shown that Bleomycin shortened the survival period, compared with untreated controls. The survival of patients treated with Cisplatinum and Bleomycin did not differ significantly from untreated patients, but Cisplatinum significantly prolonged survival. A further similar trial is reported here, the four treatment arms were Methotrexate alone, Cisplatinum alone, Cisplatinum + Methotrexate, and Cisplatinum + 5-Fluoro-uracil. The response rates were: Methotrexate alone 19%, Cisplatinum alone 40%, Cisplatinum + Methotrexate 31%, and Cisplatinum + 5-Fluoro-uracil 33%. The median survival time for the Cisplatinum alone group, 260 days, was significantly longer than the 80 days for the Methotrexate alone group. The median survival times for Cisplatinum + Methotrexate (160 days) and for Cisplatinum + 5-Fluoro-uracil (200 days) did not differ significantly from that for Cisplatinum alone.     

Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan–Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85 % for pT1/pT2, 82 % for pT3, and 76 % for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92 %, for stages III and IVa 59, 65, and 81 %, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.     

Treatment of base of tongue cancer with paclitaxel, ifosfamide, and cisplatinum induction chemotherapy followed by chemoradiotherapy

Objectives/Hypothesis: To assess the efficacy of paclitaxel, ifosfamide, and cisplatinum induction chemotherapy plus concurrent chemoradiation in the treatment of stage III and IV base of tongue cancer. Study Design: Subgroup analysis of patients with base of tongue cancer enrolled in a single‐institution prospective phase II trial, evaluating an organ‐preservation approach in the treatment of locally advanced head and neck cancer. Methods: Eighteen patients with tumors ranging from stage T2–T4, any N, or M0 were treated with a protocol of induction chemotherapy, with Taxol, ifosfamide, cisplatin every 21 days for up to three cycles. If the primary tumor exhibited a complete or partial response, patients were treated with radiation and weekly taxol and carboplatin for 7 weeks. Surgery was used for those with less than partial response or disease progression. Neck dissection was performed in cases with clinical or radiological evidence of persistent disease in the neck 6 to 8 weeks after completion of treatment. Results: Sixteen patients were male and two were female; the average age was 55 years (range, 43–65). Fifteen patients had stage IV disease and three had stage III disease. Of the 18 patients initially enrolled, 17 patients had a complete response. All 17 patients had no evidence of loco‐regional disease at a median follow‐up of 29.6 months. Only 1 of them developed distant metastases 30 months after completion of treatment. Three patients required permanent percutaneous endoscopic gastrostomy tubes because of severe dysphagia associated with concurrent chemoradiation. Conclusions: The treatment regimen studied is remarkably effective in stage III and IV base of tongue cancer with 100% of patients completing the protocol alive to date. Although some patients required persistent percutaneous endoscopic gastrostomy use, no patient experienced significant enough toxicity during the protocol to delay or withdraw from treatment.