The aim of this study was to evaluate the usefulness of a contact
neodymium YAG laser for the treatment of
squamous cell carcinoma (SCC) of the mobile tongue in 35 patients. The TNM stage and histologic grade were as follows: T1, n = 20; T2, n = 11; T3, n = 4; and N0, n = 33; N1, n = 2; G1, n = 20; G2, n = 10; and G3, n = 5. The surgical treatment consisted of a hemiglossectomy or resection with adequate margins in 28 cases, and an ipsilateral
neck dissection was also performed in 7 patients.
Radiotherapy to a mean
tumor dose of 62-64 Gy and an elective dose of 50 Gy to the cervical lymph nodes was given to 14 patients. The
radiotherapy was preoperative in 12 patients and postoperative in 2. Tongue resection was easily performed using the contact
neodymium YAG laser, with a mean operation time of 31 min and intraoperative
bleeding varying from negligible to 100 cm3. During postoperative follow-up no major complications occurred: cases with minor
hemorrhage were easily controlled on the ward and 1 patient had a bleed on the 14th postoperative day necessitating hospitalization. The resection was histologically radical in all cases. During follow-up one patient had a local recurrence (T2N0, G3) and four failed in the neck (T1N0 G2, T1N0 G2, T1N0 G2, T2N0 G2), three of whom were successfully salvaged with a
neck dissection and
radiotherapy. One patient with
osteoradionecrosis was diagnosed and treated curatively. Two patients died of their
tongue cancer (T2N0 G3, T2N0 G2), 1 died from a second primary
tumor (T2N0 G1) and 2 of intercurrent disease with no evidence of
cancer; 30 patients (86%) are still alive with no evidence of disease. The function of the tongue in all patients in this sample was good to satisfactory. The major complaint was
xerostomia in the irradiated patients. In conclusion, the contact
neodymium YAG laser appears to be suitable for resection of T1-T2 SCCs of the oral tongue. In this limited patient sample T stage or grade did not predict failures in the neck.
Biologic predictive markers need to be evaluated.