PITFALLS IN THE TREATMENT OF DELAYED LYMPH-NODE METASTASES AFTER CONTROL OF SMALL TONGUE CARCINOMAS

Between 1985 and 1992, 13 patients were treated for delayed lymphnode metastases that developed after obtaining control of primary lesions o f the tongue. ?These lesions were treated primarily by radiotherapy or surgical resection; cervical metastases were treated mainly by delaye d radical neck dissection (RND). Seven of the 13 patients survived wit h no evidence of recurrence. The other six patients developed tumors i n the neck, and five of these patients died due to uncontrollable dise ase. In all but one patient, recurrence appeared between the site of t he primary lesion and the region of RND, the oral floor and/or the par apharyngeal space. None of the patients with recurrence received radio therapy in the area between the primary lesion and the site of RND. In contrast, there was no recurrence in patients who received external i rradiation to the primary lesion and upper cervical lymph nodes. This review emphasizes the need to direct more attention to the area betwee n the site of the primary lesion and the regional lymph nodes in patie nts receiving treatment for delayed metastases associated with small c arcinomas of the tongue.