Analysis of treatment results for oral tongue cancer

OBJECTIVE: The study reports the results of treatment of oral tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: Retrospective study of 332 patients with oral 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 1957 to 1996. METHODS: Patients with biopsy-proven squamous cell carcinoma of the oral tongue who were previously untreated and were treated with curative intent by one of five modalities and who were eligible for 5-year follow-up were included. The treatment modalities included local resection alone, composite resection alone (with neck dissection), 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 rate (DSS) was 57% with death due to tumor in 43%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.61 (Kaplan-Meier) with a mean of 17.5 years and a median of 30.1 years. The DSS by treatment modality included local resection (73%), composite resection (61%), radiation therapy (46%), local resection and radiation therapy (65%), and composite resection with radiation therapy (CR/RT) (44%). Overall, local resection had a significantly improved DSS and CR/RT had a decreased DSS that was related to the stage of disease being treated. In treating stage IV disease, CR/RT produced a more significantly improved CDSS than the other treatment modalities. Recurrence at the primary site was as common as recurrence in the neck. Eighty-nine percent of recurrences occurred within the first 60 months. Recurrence significantly decreased survival. DSS was significantly improved in patients with clear margins of resection. Metastasis to a distant site occurred in 9.6% of patients. Twenty-one percent of patients had second primary cancers, and 54% of these patients died of their second primary cancer. CONCLUSIONS: Significant improvement in DSS was seen in patients with clear margins, early stage grouping and clinical (pretreatment) tumor stage, and negative nodes. Significant decrease in DSS was seen in patients with close or involved margins, advanced stage grouping and clinical (pretreatment) tumor staging, positive clinical (pretreatment) node staging, and tumor recurrence. Obtaining clear margins of resection is crucial because it significantly affects survival. A minimum of 5 years of close monitoring is recommended because of the high incidence of second primary cancers.     

Oral tongue carcinoma and its treatment in Finland

Management of oral tongue squamous cell cancer (OTSCC) remains a challenge. This nationwide study reports the used treatment approach and the outcome of OTSCC in Finland. Retrospective study of OTSCC patients in 1995–1999 with a 5-year follow-up. The corresponding data from 1980 to 1989 is also included. About 235 patients (125 M, 110 F; mean age 61.6 years; range 24–90 years) were included, 77% had SCC of lateral border of the tongue and 25% were N+. Treatment with curative intent was given to 224 (95%) patients. Surgery of the primary tumour was performed in 218 (97%) patients and with a reconstruction in 69 (31%) patients. A neck dissection was performed ipsilaterally in 114 (51%) and bilaterally in 9 (4%) cases. Irradiation was given to 131 (58%) patients. The rate for locoregional recurrence was 28%. The 3- and 5-year overall survival (OS) rates were 66 and 47%, respectively. The corresponding disease specific survival (DSS) rates were 74 and 64%, respectively. The mean DSS for patients younger than 40 years and older than 40 years was 111 and 88 months, respectively (P < 0.02). The 3- and 5-year DSS rates were: Stage I, 88 and 74%; Stage II, 74 and 62%; Stage III, 79 and 71% and Stage IV, 36 and 33%, respectively. In the present study the surgical treatment approach seems effective in controlling early stage OTSCC but the modest survival, in spite of combination of radiotherapy and surgery, points out the need to consider new strategies in the management of advanced stage disease.     

A protocol for combined treatment of cancer of the oral cavity and tongue

A protocol for combined treatment of carcinoma of the oral cavity and tongue as practiced at the Mason Clinic for the past five years is presented. This protocol combines surgery with postoperative radiation therapy, and the initial results are presented. Comparison of the results at this institution at the one, three, and five year level for tongue, oral, and pharyngeal cancer compared to other peer group reporting rates, as surveyed by the Commission on Cancer Audit of the American College of Surgeons, indicates that our results compare favorably to those of other institutions. Apparent increase in local control, a probable increased cure rate, together with marked decrease in hospital time and multiplestaged procedures are noted. Disseminated distal metastasis has not been a major problem and is discussed.     

面动脉-颏下岛状皮瓣修复舌癌术后改良口腔护理

目的 探讨面动脉-颏下岛状皮瓣修复舌组织缺损后,改良口腔护理所起的临床作用。方法 选择应用面动脉-颏下岛状皮瓣,对舌癌根治性切除术后舌组织缺损进行同期修复的15例T2N0M0舌癌患者,对其术后的不同时期,进行针对性的改良口腔护理。结果 本组患者术后岛状皮瓣全部存活,改良护理提高手术成功率,保证患者生存质量。 结论 面动脉-颏下岛状皮瓣修复舌癌术后应用改良口腔护理,减少并发症发生。     

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.     

游离腹壁下动脉穿支皮瓣应用于舌癌术后缺损修复与舌再造

目的探讨游离腹壁下动脉穿支皮瓣应用在舌癌术后缺损修复与舌再造中的效果。方法2008年12月~2016年1月应用游离腹壁下动脉穿支皮瓣对42例舌癌患者行舌癌根治术同期行舌口底缺损修复与舌再造,其中舌缘癌22例,舌腹癌17例,口底癌累及舌3例,肿瘤根治术后形成6.5 cm×3.5 cm～11.0 cm×7.5 cm大小缺损。术中将腹壁下动脉与甲状腺上动脉吻合,伴行静脉与甲状腺上静脉或颈内静脉吻合。结果皮瓣长(8.6±0.3)cm、宽(5.1±0.2)cm、厚(2.3±0.5)cm。腹壁下动脉穿支皮瓣血管蒂长度为(9.6±0.4)cm。42例肌皮瓣全部存活,供区直接闭合。皮瓣外观满意,供区仅遗留线性瘢痕,腹直肌功能未见明显影响。随访14～64个月。再造舌形态良好,吞咽、语言功能满意,肿瘤局部无复发。结论腹壁下动脉穿支皮瓣组织量丰富,质地好,再造舌外形及功能良好,供区损伤小,是舌癌术后舌、口底缺损修复与舌再造的理想选择。     

舌根癌的手术治疗

目的：探讨舌根癌的手术治疗方法。方法：舌根癌患者21例，经舌骨咽切开进路11例，下颌骨部分切除进路7例，下唇、下颌骨、舌正中切开进路3例。结果：3例下唇、下颌骨、舌正中切开者出现语言功能障碍，吞咽困难；余18例口腔功能均正常。随访2～5年，失访2例，2年生存18例，3年生存13例，5年生存5例。结论：经舌骨咽切开进路对吞咽功能及语言功能的影响较小，是一种值得推广的术式。     

Tongue pressure in patients with tongue cancer resection and reconstruction

Objective

Assessment of tongue function following tongue reconstruction is important to evaluate patient status. To assess tongue function in patients who had undergone tongue reconstruction, the surgical team used a simple, hand-held tongue pressure measurement device to measure tongue power.

Methods

Tongue power of 30 patients (25 males, 5 females; average age: 53.6 ± 15.0 years) was calculated using a hand-held tongue pressure measurement device, six months postoperation. The defects were classified into minimal glossectomy (MG) (n = 8), near-half partial glossectomy of the mobile tongue (PG) (n = 5), hemi-glossectomy (HG) (n = 4), more than half partial glossectomy of the mobile tongue (SG-MT) (n = 7), and subtotal glossectomy (SG) (n = 6). As seen in other tongue assessments, a simple articulatory test, food evaluation, and speech intelligibility assessment were also performed; resulting correlations were statistically calculated using tongue pressure values.

Results

The tongue pressure values were 94.0 ± 14.5% in MG, 48.5 ± 13.2^a % in PG, 40.4 ± 18.7^a % in HG, 19.3 ± 7.7^a,b % in SG-MT, and 15.3 ± 5.6^a,b % in SG (a: <0.05 vs. MG, b: <0.05 vs. PG). The Pearson r was 0.77, 0.67, and 0.74 when correlated with simple articulatory test, food evaluation, and speech intelligibility assessment, respectively.

Conclusion

Tongue pressure measurement in patients with tongue cancer resection and reconstruction facilitated determination of patients’ tongue function status.     

The infrahyoid myocutaneous flap for reconstruction after oral cancer resection: A retrospective single-surgeon study

ObjectiveTo review our experience with infrahyoid myocutaneous flap in reconstruction after oral cancer resection.MethodsChart reviews were completed for all patients who underwent oral reconstruction with an infrahyoid myocutaneous flap by a single surgeon in the Department of Otolaryngology at Chonburi Cancer Hospital from 2011 to 2017. Characteristics of the patients and postoperative complications were analyzed.ResultsOf the 34 patients in the study, 10 (29.4%) developed partial flap loss and 1 (2.9%) developed total flap loss. All cases of partial flap loss resolved with conservative treatment. Apparent cancer involvement of a cervical lymph node was significantly associated with flap failure (odds ratio: 5.0, 95% CI: 1.03–24.28).ConclusionsThe infrahyoid myocutaneous flap is a fairly reliable reconstruction method. The flap should be performed with caution in cases with gross lymph node involvement.     

Usefulness of sentinel node navigation surgery in the management of early tongue cancer

Objective

To determine the validity of sentinel node navigation surgery (SNNS) in early stage tongue cancer, the occurrence rate of postoperative cervical metastasis (POCM) after lead plate technique (LPT) introduction and survival rates in patients who underwent SNNS were analyzed.

Methods

SNNS was performed in 29 patients (stage I: 14, stage II: 15) from 2000 to 2007. Tc-labeled phytate was prepared as a radiotracer a day before SNNS. The sentinel node (SN) was then examined pathologically during surgery. For cases where metastasis in SN was positive, neck dissection was performed. Occurrence of POCM after LPT introduction was compared with that before LPT introduction. ‘Wait and see’ policy was performed in 52 patients (stage I: 27, stage II: 25) from 1987 to 1999 as a historical control. The observation period of SNNS cases and ‘wait and see’ policy cases ranged from 10 months to 165 months (median: 91 months) and from 7 months to 268 months (median: 87 months), respectively.

Results

Six of the 29 SNNS cases (21%) were proven metastatic SNs. Before LPT introduction, POCM occurred in 2 of the 15 cases, while we had no occurrences after LPT introduction. The 5-year overall survival rate of the 29 patients who underwent SNNS and the 52 patients with ‘wait and see’ policy were 96% and 84%, respectively, and there was statistical significance in the two groups (p < 0.05).

Conclusions

As the survival rate of the patients with the SNNS tended to be better than that with the ‘wait and see’ policy in our cases, SNNS could avoid unnecessary neck dissection. SNNS provides useful information regarding decision-making for neck dissection in early stage tongue cancer.     

Surgery in early cancer of the oral tongue (Tl-2). Wide excision versus hemiglossectomy

Cancer of the oral tongue is a common disease. Thirty five (35%) percent of patients seen at our hospital are in Stages I&II. The choice of surgical treatment is a wide excision of the lesion (WE) or a hemiglossectomy (HG). This study was carried out to compare the local recu-rrences and survival in patients undergoing either a WE or HG for early cancer of the tongue. One hundred and twenty six (126) patients were evaluated, 40 underwent a WE and 86 HG. The local recurrence was higher in the WE group, 25% compared with 9% in the HG group; which is statistically significant (p=0.02). This was also seen in the Tl subgroup (p=0.003). Survival were better in the HG group (p=0.005), which was also seen for the Tl subgroup (p=0.004). Our study demonstrates that there is a lower incidence of local recurrences following a hemiglossectomy for Tl-2 tumours of the oral tongue with improved survivals. Our recommendation is that hemi-glossectomy should be the optimal surgery performed for early cancer of the oral tongue.     

The patterns and treatment of recurrence following radiotherapy for carcinoma of the oral cavity

In many centres carcinoma of the oral cavity, if relatively early, is treated by irradiation. The present study includes 186 patients treated in this manner. The primary recurrence rate for previously untreated patients was 34% and was not significantly affected by host or tumour factors. The 5-year survival for the 144 previously untreated patients was 65%, and salvage surgery offered a 35% chance of cure. Survival was reduced in patients aged 60 years and over (p < 0.02). The recurrence rate in cervical lymph nodes following radiotherapy was 38% and was more likely to occur for primary sites in the tongue and floor of mouth (p < 0.01). The five-year survival rate after nodal recurrences was 31% and was predicted only by the presence of extracapsular rupture (P < 0.01). One-third of patients had died of causes other than the primary tumour at 5 years and one-third had died of the original tumour. The rest of the patients are alive and well, only 7% having had a major resection. We feel that the present policy has optimum cure rate whilst saving most patients from major surgery.     

Oropharyngeal carcinoma and its treatment in Finland between 1995–1999: a nationwide study

The survival figures for advanced stage oropharyngeal carcinoma (OPC) have remained moderate in spite of radical combined modality treatments. The purpose of this study was to investigate the used treatment approach and the outcome of OPC in a nationwide study. Retrospective clinicopathological data of all patients diagnosed with OPC between 1995 and 1999 at the five university hospitals in Finland were reviewed. All patients had a minimum 4-year follow-up. A total of 168 patients (145 men and 23 women, mean age 59 years; range 28 – 89 years) were included. The T categories were as follows: T1, n =34; T2, n =55; T3, n =40; T4, n =39. One hundred and seventeen (69.6%) patients presented with neck node metastases and three (1.8%) patients with distant metastases. In the majority (61.3%) of the patients the tumor was located in the lateral wall of the oropharynx. In 144 (85.7%) patients the treatment was performed with curative intent. Of these, surgery of the primary tumor was performed in 123 (85.4%) patients, and the defect was reconstructed with a pedicled flap or free tissue transfer in 66 (53.7%) of these patients. A neck dissection (ND) was performed in 86 (69.9%) out of these 123 cases. Surgery was the only treatment modality in 10 (6.9%) patients. Radiation therapy (RT) only (with or without chemotherapy) was given to 21 (14.6%), combined treatment with surgery + radiation therapy (S + RT) to 110 (76.4%) and surgery + chemoradiotherapy (S + CRT) to 3 (2.1%) patients. Overall (OS) 3- and 5-year survival rates were 58 and 45%, respectively. Disease-specific (DSS) 5-year survival rates by T-class for the patients treated with curative intent were as follows: T1, 77%; T2, 70%; T3, 66%; T4, 53%. The variable treatment approach, the frequent locoregional recurrences and the moderate survival point out the need to consider new strategies in the management of OPC.     

Angiosarcoma of the tongue: A case series and literature review

Purpose

Angiosarcoma of the tongue is an exceedingly rare malignancy of the head and neck. Such lesions can be primary in nature or occur in a previously irradiated field. We examine a series of cases with relation to clinical presentation, diagnosis, management, and outcomes.

累及舌根的头颈部恶性肿瘤保留吞咽和喉功能的手术方法

目的 探讨保留累及舌根的头颈部恶性肿瘤吞咽和喉功能的有效手术方法.方法 回顾性分析2003年1月至2008年12月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的31例累及舌根的头颈部恶性肿瘤患者的临床资料,男27例,女4例.舌根原发恶性肿瘤9例,累及舌根的扁桃体鳞癌3例,声门上型喉癌累及舌根11例,下咽癌累及舌根8例.术中按照舌动脉的临床解剖,最大限度保留一侧舌动脉和正常的舌根部组织,若术前CT提示双侧舌动脉受侵犯,行全舌切除;根据喉功能的保护机制,最大限度保留会厌、室带、声带.结果 术后31例患者均未发现残舌坏死.5例行全喉切除术和1例行全舌根切除术的患者终身带管,其余25例皆在14～90 d拔出气管套管并保留喉功能,并于术后10～31 d经口进食.2例累及舌根的下咽癌术后咽瘘,换药治疗2周后愈合;2例舌根癌和1例扁桃体癌累及舌根术后感染皆在2周左右治愈.中位随访时间36个月,Kaplan-Meier法统计3年和5年生存率分别为79.5%和69.6%.结论 累及舌根的头颈部恶性肿瘤的手术治疗,术中可根据舌动脉的临床解剖和喉功能的保护机制对原发肿瘤和舌根部分切除及修复,是最大限度保留吞咽和喉功能的有效方法.     

累及舌根的头颈部恶性肿瘤保留吞咽和喉功能的手术方法

目的 探讨保留累及舌根的头颈部恶性肿瘤吞咽和喉功能的有效手术方法.方法 回顾性分析2003年1月至2008年12月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的31例累及舌根的头颈部恶性肿瘤患者的临床资料,男27例,女4例.舌根原发恶性肿瘤9例,累及舌根的扁桃体鳞癌3例,声门上型喉癌累及舌根11例,下咽癌累及舌根8例.术中按照舌动脉的临床解剖,最大限度保留一侧舌动脉和正常的舌根部组织,若术前CT提示双侧舌动脉受侵犯,行全舌切除;根据喉功能的保护机制,最大限度保留会厌、室带、声带.结果 术后31例患者均未发现残舌坏死.5例行全喉切除术和1例行全舌根切除术的患者终身带管,其余25例皆在14～90 d拔出气管套管并保留喉功能,并于术后10～31 d经口进食.2例累及舌根的下咽癌术后咽瘘,换药治疗2周后愈合;2例舌根癌和1例扁桃体癌累及舌根术后感染皆在2周左右治愈.中位随访时间36个月,Kaplan-Meier法统计3年和5年生存率分别为79.5%和69.6%.结论 累及舌根的头颈部恶性肿瘤的手术治疗,术中可根据舌动脉的临床解剖和喉功能的保护机制对原发肿瘤和舌根部分切除及修复,是最大限度保留吞咽和喉功能的有效方法.     

Possible prognostic value of histopathologic parameters in patients with carcinoma of the oral tongue

The current TNM staging system is helpful but still not enough to accurately determine prognosis of the patients with squamous cell carcinomas of the oral tongue. Histopathologic variables, however, may be more helpful for predicting nodal metastasis and locoregional recurrences. In this respect, histopathologic examinations were done retrospectively of tumor specimens from 60 patients with squamous cell carcinomas of the oral tongue. Besides T-stage and nodal involvement, histopathologic parameters of tumor thickness, perineural invasion, lymphovascular space invasion, the extent of lymphocyte infiltration and the invasion pattern statistically correlated with locoregional recurrences. For nodal metastasis, tumor thickness of 10 mm or more and the type of invasion pattern were statistically significant. These results revealed that the variables described should be used for managing oral tongue cancers. Received: 16 June 1997 / Accepted: 19 September 1997     

Swallowing and tongue function following treatment for oral and oropharyngeal cancer.

This study examined tongue function and its relation to swallowing in 13 subjects with oral or oropharyngeal cancer treated with primary radiotherapy +/- chemotherapy and 13 age- and sex-matched control subjects. Measures of swallowing and tongue function were obtained using videofluoroscopy, pretreatment and 2 months posttreatment. Maximum isometric strength and endurance at 50% of maximum strength were obtained with the Iowa Oral Performance Instrument (IOPI). Control subjects were tested once. All subjects with head and neck cancer were evaluated pretreatment and 2 months posttreatment. No significant differences were found for the tongue function measures pre- and 2 months posttreatment in the group with head and neck cancer. Significantly higher tongue strength was observed in the control than in the group with head and neck cancer both pre- and posttreatment. No significant differences were found for the 2 groups for tongue endurance measures. Significant correlations of tongue strength and endurance and some swallow measures were found pre- and posttreatment for the group with head and neck cancer and for the control group. These correlations included oral and pharyngeal temporal swallow measures and oropharyngeal swallow efficiency. Pretreatment differences between the 2 groups in tongue strength were likely related to tumor bulk, pain, and soreness. Two-month posttreatment differences were likely related to radiation +/- chemotherapy changes to the oral and pharyngeal mucosa. This study provides support for the hypothesis that tongue strength plays a role in oropharyngeal swallowing, particularly related to the oral phase of the swallow.     

Carcinoma of the oral tongue: A study of patient selection and treatment results

Retrospective review of 118 primarily treated cancers of the oral tongue was done to study patient selection and to search for improved treatment strategies. Small surface lesions were treated by local excision (LE); most small lesions invading muscle of the tongue without lymph node metastases were treated by radiation alone (RA) while larger lesions and those with palpable nodes were treated by preoperative radiation and surgery (R+S). Ultimate control of the primary tumor and lymph nodes after initial treatment and surgical salvage was high for the lesions treated by LE (91%), the T1N0 lesions treated by RA (88%) and for the TxN+ lesions treated by R+S (57%). Improved treatment strategies are suggested for T2N0 lesions treated by RA because of poor tumor control (53%) and a high rate of radiation complications (25%), and for T3N0 lesions because so many of these patients died from causes other than cancer within two years. Second primary cancers were most common in those patients with a good prognosis.