Management of cervical metastases in advanced squamous cell carcinoma of the base of tongue.

Abstract

OBJECTIVE:

To clarify the role of neck dissection following primary radiotherapy for treatment of squamous cell carcinoma of the base of tongue.

DESIGN:

Case series.

SETTING:

Academic, tertiary care medical center.

PATIENTS OR OTHER PARTICIPANTS:

A consecutive series of 45 patients with biopsy-proven squamous cell carcinoma of the base of tongue and cervical metastases treated with primary radiotherapy at The University of California, San Francisco, was examined. Patients with a prior history of neck irradiation, neck dissection, or head and neck cancer within 5 years were excluded.

MAIN OUTCOME MEASURES:

Overall survival and regional control.

RESULTS:

Of the 45 patients treated with definitive radiotherapy, 25 (56%) achieved a complete response, 13 (29%) achieved a partial response, 4 (9%) were nonresponders, and 3 (7%) did not complete radiotherapy. Two thirds of the complete responders had N2 or N3 disease; 3 had recurrences in the neck, 1 of which was an isolated neck recurrence. Of the 13 partial responders, 5 had isolated persistence of disease, with 4 undergoing neck dissections. The only long-term survivors among the partial responders were those 4 who underwent a neck dissection. Overall survival was 50% at 3 years and 32% at 5 years. Regional control for complete responders was 84% at 5 years.

CONCLUSIONS:

The low rate of isolated regional recurrence in patients with a complete response to radiotherapy supports the practice of surveillance alone in such patients. Patients with less than a complete response appear to benefit from prompt surgical salvage.

• Authors: Steven D Pletcher, Michael J Kaplan, David W Eisele, Mark I Singer, Jeanne M Quivey, Nancy Lee
• Journal: Archives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 129 Issue 9 Pg. 983-6 (Sep 2003) ISSN: 0886-4470 [Print] United States
• PMID: 12975272 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (pathology, radiotherapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Mandible (pathology)
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Osteoradionecrosis (etiology, pathology)
• Radiotherapy (adverse effects)
• Tongue Neoplasms (pathology, radiotherapy)