Merkel cell carcinoma of the tongue base

Merkel cell carcinoma (MCC) is a rare but very aggressive tumour of neuroendocrine origin, usually seen in sun‐exposed parts of the body. Very few cases of MCC in the oral cavity have been reported. A new MCC case in the tongue base was reported in our hospital. Prompt diagnosis and early robotic surgery successfully removed the tumour with a clear margin for an early‐stage tumour.     

Squamous cell carcinoma of the base of the tongue

The squamous cell carcinomas of 119 patients treated between 1958 and 1980 were retrospectively reclassified according to the 1977 American Joint Committee for Cancer Staging-End Results Reporting guidelines. Analysis of the information was performed with an interactive computer program that allows the analysis of a large number of medical factors with numerous variables. The following factors show the statistically significant improved survival rates: well-differentiated histopathologic findings, small T-stage lesions, and clinically negative neck disease. Although the survival curve was similar in the planned combined therapy and radiation therapy groups, local control was statistically superior in the combined therapy group. A similar trend is seen in those patients who receive interstitial implants in addition to external beam therapy. A randomized prospective study is needed to determine the optimum mode of therapy.     

Definitive radiotherapy with interstitial implant boost for squamous cell carcinoma of the tongue base

BACKGROUND: The purpose of this study was to examine the long-term outcome of a cohort of patients with unresected base of tongue carcinoma who received interstitial brachytherapy after comprehensive external beam radiation therapy. METHODS: Between 1983 and 2000, 122 patients with primary or recurrent squamous cell carcinoma of the oropharynx or oral cavity received interstitial brachytherapy as part of their overall management. Forty patients had primary, unresected carcinoma of the base of tongue and are the subjects of this analysis. The median age was 54 years. Fifty-four percent had T3 or T4 disease, and 70% had clinical or radiographic lymphadenopathy. Twenty-four (60%) received two to three cycles of neoadjuvant chemotherapy. The oropharynx, bilateral neck, and supraclavicular fossae were comprehensively irradiated, and the tongue base received a median external beam dose of 61.2 Gy (50-72 Gy). The primary site was then boosted with an interstitial 192Iridium implant by use of a gold-button single-strand technique and three-dimensional treatment planning. The dose rate was prescribed at 0.4 to 0.5 Gy/hr. The median implant dose was 17.4 Gy (9.6-24 Gy) and adjusted to reach a total dose to the primary tumor of 80 Gy. N2 to 3 disease was managed by a planned neck dissection performed at the time of the implant. RESULTS: The median follow-up for all patients was 56 months, and the overall survival rates were 62% at 5 years and 27% at 10 years. The actuarial primary site control was 78% at 5 years and 70% at 10 years. The overall survival and primary site control were independent of T classification, N status, or overall stage. Systemic therapy was associated with an improvement in overall survival (p = .04) and a trend toward increased primary site control with greater clinical response. There were seven documented late effects, the most frequent being grade 3 osteonecrosis (n = 2), grade 2 swallowing dysfunction (n = 2), trismus (n = 2), and chronic throat pain (n = 1). CONCLUSIONS: In an era of greatly improved dose distributions made possible by three-dimensional treatment planning and intensity-modulated radiation therapy, brachytherapy allows a highly conformal dose to be delivered in sites such as the oropharynx. If done properly, the procedure is safe and delivers a dose that is higher than what can be achieved by external beam radiation alone with the expected biologic advantages. The long-term data presented here support an approach of treating advanced tongue base lesions that includes interstitial brachytherapy as part of the overall management plan. This approach has led to a 78% rate of organ preservation at 5 years, with a 5% incidence of significant late morbidity (osteonecrosis) that has required medical management.     

Surgical treatment of squamous cell carcinoma of the base of tongue.

INTRODUCTION: Squamous cell carcinoma (SSC) of the tongue base has historically been shown to be associated with a poor prognosis. We reviewed our experience with primary surgery followed by postoperative radiation therapy (XRT) to determine the impact of our treatment protocols on outcome. METHODS: We retrospectively reviewed the records of all patients presenting to the University of Pittsburgh with previously untreated SSC of the tongue base between 1980-1997. Patients who were treated nonoperatively were excluded from analysis. Surgical excision of the primary was performed with ipsilateral neck dissection. The contralateral neck was dissected when the primary lesion was located in the midline or for clinically positive contralateral neck nodes. Postoperatively, most patients (93%) received XRT to the primary site and neck. Adjuvant chemotherapy was offered if histologic signs of aggressive behavior were identified (multiple nodes or extracapsular spread). RESULTS: Of 87 patients identified, 39 (45%) were initially seen with T1 or T2 tumors. Seventy-nine patients (91%) were initially seen with stage III or IV disease. Contralateral neck dissection was performed in 36 patients (41%). Metastatic disease was demonstrated in 84% of ipsilateral neck nodes and in 47% of contralateral neck nodes. Occult metastases were found in 61% of clinically N0 necks. Local recurrence occurred in 5 patients, regional recurrence occurred in 12 patients, and distant metastases developed in 22 patients. Overall and disease-specific survival rates at 5 years for all patients were 49% and 56%, respectively. The 5 year disease-specific survival rates for stage I, stage II, stage III, and stage IV disease were 100%, 86%, 62%, and 48%. The 5-year disease-specific survival rate was 88% for T1 lesions, 64% for T2 lesions, 58% for T3 lesions, and 30% for T4 lesions (p <.05, log-rank test). CONCLUSIONS: Surgical treatment of SCC of the tongue base is highly effective in achieving local disease control and disease-free survival for early lesions. Because both functional outcome and survival are poor after surgical treatment of advanced lesions, we now offer brachytherapy with XRT or participation in a combined chemoradiation protocol rather than primary surgical therapy to patients with advanced disease. Prospective studies are needed to compare the effect of these organ-preserving therapies with traditional combined surgery and XRT to determine the effect on functional outcome and quality of life.     

Functional status after primary surgical therapy for squamous cell carcinoma of the base of the tongue

INTRODUCTION: Quality-of-life analysis is essential in determining the eventual outcome after treatment for head and neck cancer. This is particularly important when functional sequelae of treatment cause significant morbidity. The purpose of this study is to evaluate the functional status of a group of patients who had undergone primary surgical therapy for squamous cell carcinoma of the base of the tongue. METHODS: At our institution from 1979 to 1993, we identified 93 patients who had undergone resection of the base of the tongue as primary treatment for squamous cell carcinoma. Patients who required laryngectomy were excluded from this group. Forty-eight survivors were identified, and the questionnaires included the Performance Status Scale for Head and Neck Cancer Patients (PSS) and the Karnofsky Performance Status Scale (KPS). The data were reported numerically, with 0 representing the worst score and 100 representing the best score. RESULTS: Twenty-six patients completed the questionnaires. There were 19 men and 7 women. Their mean survival time was 8.6 years. Two patients had their primary tumors staged as T1, 17 patients had T2, and 7 patients had T3 disease. When evaluating the normalcy of diet, the mean score for the whole group was 73.1 (range, 20-100), the mean score for understandability of speech was 80.8 (range, 50-100), and the mean score for eating in public was 79.8 (range, 0-00). The mean KPS was 90 (range, 60-100). When comparing early (T1 and T2) with advanced (T3) disease, there were no significant differences in PSS and KPS. When comparing younger (<50 years) with older (>50 years) patients, there were no significant differences in PSS scores. Younger patients had a significantly higher KPS than older patients: mean, 97.5 vs 86.4 (p <.02). CONCLUSIONS: The long-term functional status for these patients who had undergone resection of a significant portion of the base of their tongue was good. The outcome did not seem to be related to either the stage of the lesion or the age of the patient. More studies are needed to examine the functional outcome of this patient population.     

Squamous cell carcinoma of the tongue: a comparison of the anterior two thirds of the tongue with its base

A retrospective analysis of 176 patients with squamous cell carcinoma of the tongue has been reported. The tongue base and mobile tongue, believed to behave as two clinically distinct anatomic areas, have been compared and contrasted. Women comprised 25 percent of the patients with tumors of the base of the tongue and 45 percent of those with mobile tongue lesions, an increase over previous reports for both locations. The majority of patients with squamous cell carcinoma of the tongue base (77 percent) presented with advanced (stage III or IV) lesions at time of initial clinical and diagnostic staging, compared with only 33 percent of those with cancer of the mobile tongue. There was no significant difference in survival between the two locations when survival rates were compared stage by stage. The decreased overall survival frequently reported for patients with squamous cell carcinoma of the tongue base compared with the survival for patients with tumors of the mobile tongue may be due to the disproportionately high number of patients with cancer of the tongue base who present with advanced disease. Survival rates have not significantly improved when compared with other retrospective series reported in the past 40 years. We strongly urge the development of intercenter, multidisciplinary, cooperative, prospective, protocols to assess combinations of currently accepted therapeutic modalities in the hope of improving treatment of this devastating disease.     

Treatment of cervical lymph nodes in carcinoma of the tongue

Treatment of the regional lymph nodes forms an integral part of the management of any patient with carcinoma of the tongue. It is the most important determinant of survival. Although survival correlates with the size of the primary tumor, it may also be explained by the higher incidence of metastatic nodes in larger lesions. The incidence of contralateral neck nodes is high, and treatment of the contralateral neck, even in smaller carcinomas of the tongue, must be considered. Anterior tongue carcinomas are equally as aggressive as posterior carcinomas of the tongue. An analysis of the cause of failure following treatment of tongue carcinomas emphasizes the fact that too many clinical stages I and II cancers—those with clinically negative neck examination—are in fact pathologic stage III cancers.     

Renal cell carcinoma metastatic to the base of tongue: a case report

A 66-year-old male patient underwent left radical nephrectomy for stage III renal cell carcinoma (RCC) two years and eight months previously. He complained of discomfort at his pharynx. An otolaryngeal examination revealed a tumor about 1.3 cm in size at the base of tongue, and the tumor was resected. It was pathologically diagnosed as clear cell carcinoma and as tongue metastasis of RCC. The subsequent appearance of a minute pulmonary metastasis caused the administration of interferon-alpha and interleukin-II. At present, two years after the treatment, neither growth of lung metastasis nor recurrence of tongue tumor are noticed. Tongue metastasis of RCC is rare and its prognosis is poor. This is the 17th case reported in Japan.     

Lymphatic malformations of the tongue base

Purpose

In light of the paucity of literature on lymphatic malformations of the tongue base, our aim was to present our experience and long-term outcomes of patients with this rare and challenging pathologic entity.

Methods

Medical records of 25 patients treated by the 3 senior authors (RGA, MTC, and RTC) between 1974 and 2003 were retrospectively reviewed, and comprehensive clinical data were collected and analyzed.

Results

Twenty-one patients (13 female and 12 male infants) were diagnosed either prenatally or at birth. Of these patients, 18 required early airway stabilization; 17 required tracheotomy. Four patients were diagnosed after 1 year of age and had no airway problems. Follow-up ranged from 2 days (owing to death) to 28 years, with a mean of 10 years. In 21 patients, pathology was extensive, involving contiguous anatomical areas such as the anterior tongue, larynx, pharynx, and floor of mouth. Multiple resections and debulking procedures were performed to restore function and improve cosmesis. Four patients died, all with laryngeal involvement. Of the 14 survivors who had tracheotomies, only 5 are decannulated. Normal oral feeding has been achieved in 14 patients and normal speech, in 8 patients. Cosmesis has improved with time. Orthodontic and dental problems are common, and 9 patients have significant macrognathia.

Conclusions

Although most patients with lymphatic malformations of the tongue base achieve normal oral feeding, airway, speech, and cosmesis issues remain problematic throughout life. Laryngeal involvement signifies extensive disease and is the most significant risk factor for serious complications and death.     

Adenoid cystic carcinoma of the base of the tongue: Late metastasis to the pancreas

Adenoid cystic carcinoma (ACC) is a relatively rare epithelial tumor of the salivary glands. We present a 64-year-old gentleman with ACC of the tongue who following resection and radiotherapy, presented 10 years later with a lung metastasis and underwent operative intervention and further radiotherapy. Five years later he presented with obstructive jaundice found to be metastatic ACC. We believe this to be the first report of an ACC metastasizing to the pancreas.     

Treatment of carcinoma of the oral tongue by radium needle implantation

Forty-nine patients had a radium implant for carcinoma of the oral tongue. In thirty-four of the forty-nine (70 per cent), local three year control of the cancer was achieved. Three patients in whom the radiation failed were rescued by subsequent surgery. The five year absolute survival in this series was 63.8 per cent. In conclusion, we believe that improved survival rates without functional and cosmetic defect can be obtained by closer cooperation between surgeons and radiotherapists.     

The National Cancer Data Base report on squamous cell carcinoma of the base of tongue

BACKGROUND: This study provides the largest contemporary overview of presentation, care, and outcome for base of tongue squamous cell carcinoma (SCC). METHODS: We extracted 16,188 cases from the National Cancer Data Base (NCDB). Chi-square analyses were performed on selected cross-tabulations. Observed and disease-specific survival were used to analyze outcome. RESULTS: Three-quarters had advanced-stage (III-IV) disease. Radiation therapy alone (24.5%) and combined with surgery (26.9%) were the most common treatments. Five-year observed and disease-specific survival rates were 27.8% and 40.3%, respectively. Poorer survival was significantly associated with older age, low income, and advanced-stage disease. For early-stage disease, surgery with or without irradiation had higher survival than irradiation alone. For advanced-stage disease, surgery with irradiation had the highest survival. CONCLUSIONS: Survival rates were low for base of tongue SCC, with most deaths occurring within the first 2 years. Income, stage, and age were significant prognostic factors. In this nonrandomized series, surgery with radiation therapy offered patients with advanced-stage disease the best survival.