Elective versus therapeutic neck dissection in early carcinoma of the oral tongue

Article Abstract:

Carcinoma of the tongue is effectively treated by surgical removal, but, given time, the cancer often spreads to the neck region. Currently there is little agreement among physicians regarding the best way to manage these cases, therefore, most adopt a watch-and-wait policy to avoid unnecessary surgery. However, over 60 percent of these patients die of neck-related disease. Ninety-five patients who had either part of their tongue removed (hemiglossectomy) or a hemiglossectomy plus elective radical neck dissection (RND, removal of lymph nodes and other tissues) were evaluated every two months for the first year after surgery and every four months thereafter to evaluate any advantage of elective RND for survival and recurrence rates. Seventy patients who completed at least 12 months of follow-up examinations were divided into two groups depending on the nature of the surgery: group 1 (40 patients) had hemiglossectomy alone and group 2 (30 patients) had both hemiglossectomy and RND. No statistically significant difference in disease-free survival rate was observed between the groups (52 percent for group 1 and 63 percent for group 2). However, in either group, a greater chance of cancer affecting the lymph nodes in the neck was observed when the tumor was more than 4 millimeters (mm) deep. Therefore, the following recommendations on the treatment of patients with early carcinoma of the tongue are made: (1) hemiglossectomy should be performed and tumor depth recorded, (2) patients with a tumor depth of less than 4 mm should be reevaluated every two months, (3) when the tumor is deeper than 4 mm, neck dissection should be performed 8 to 12 weeks after removal of the primary tumor (this reduces the risk of accidentally transferring carcinoma cells to the neck during removal of the primary tumor). It is suggested that neck dissection is not essential for all patients, and by following these guidelines for the management of tongue cancer patients, unnecessary surgery may be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Radical neck dissection

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Supraomohyoid neck dissection with frozen section biopsy as a staging procedure in the clinically node-negative neck in carcinoma of the oral cavity

Article Abstract:

To plan the best treatment and evaluate patient outcome, accurate staging of cancer is important. The prognosis of cancers of the head and neck is strongly influenced by the presence and extent of cancer spread (metastasis) to the lymph nodes. A single cancer neck lymph node decreases survival by 50 percent; bilateral nodes (nodes on both sides) decreases survival by 75 percent. The best treatment for oral cancer remains controversial; elective neck dissection can result in significant, unnecessary morbidity such as loss of function or disfiguration. A report is presented of the use of supraomohyoid neck dissection, a less radical procedure, to determine the stage of the oral cancer at the time of surgery. This procedure is less extensive than radical neck dissection and selectively removes lymph nodes most likely to contain metastasis from oral cavity cancers; frozen section biopsy of suspicious lymph nodes is performed. This procedure was performed on 57 patients who were newly diagnosed with squamous cell cancer of the oral cavity. Frozen section biopsy revealed metastasis in 10 patients; these patients had radical neck dissection. Ten patients were identified with occult lymph node metastasis at other sites. Where tissue study showed no metastasis in the removed specimens, there were only three patients (7 percent) who ultimately developed recurrence. It is concluded that supraomohyoid neck dissection using frozen section biopsy is helpful in planning the extent of surgical treatment for patients with primary cancer of the oral cavity who have no palpable evidence of lymph node involvement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Diagnosis, Cancer metastasis, Tumor staging, Cancer staging, Head and neck cancer, Lymphatic metastasis

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Treatment selection for carcinoma of the base of the tongue

Article Abstract:

Patients with squamous cell cancer of the base of the tongue do not develop symptoms until the disease is far advanced. Surgical treatment often results in impaired speech and swallowing; definitive radiotherapy preserves function but does not control the disease. A review was undertaken of 173 patients treated for squamous cell cancer of the base of the tongue to identify clinical factors influencing outcome and to determine the best treatment at each stage of the disease. Tumors were staged; 54 patients had T1 or T2 tumors, 115 had T3 or T4 tumors, and 4 were unable to be staged. There were 120 patients with lymph node metastasis. Patients with early primary tumors that had been treated with surgery were controlled in 83 percent (5 of 6) of the cases; those treated with radiotherapy, 89 percent (40 of 45). Radiotherapy controlled the tumor in only 55 percent of the patients who had advanced primary tumors; this is compared with 79 percent of patients with advanced primary tumors who were treated with surgery and postoperative radiotherapy. When primary tumor control was obtained, the rate of failure (spread of cancer) within the region was 10 percent. At two years, the primary control rate for 21 patients with exophytic (growing outward) tumors was 84 percent, compared with 58 percent for 62 patient with ulcerative-infiltrative tumors. It is concluded that radiotherapy is effective in controlling early stage or exophytic tumors. When there are advanced or deeply invasive tumors, a combination of surgery and radiotherapy improves the local tumor control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Management, Complications and side effects, Therapeutics, Cancer treatment, Radiotherapy

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