SUPRAOMOHYOID NECK DISSECTION IN THE TREATMENT OF T1 T2 SQUAMOUS-CELLCARCINOMA OF ORAL CAVITY/

BACKGROUND: Recent studies in patients with previously untreated T1 an d T2 squamous cell carcinoma (SCC) of the tongue and floor of the mout h have shown a relationship between tumor thickness, neck metastasis, and survival. Our study was conducted to determine the indication of e lective neck dissection in patients with early oral cavity SCC. PATIEN TS AND METHODS: Sixty-seven patients were stratified by stage (T1 and T2 NO), and those in each stage were randomized to receive one of two types of treatment; resection alone (RA) or resection plus elective su praomohyoid neck dissection (RSOND). Fifty-two patients (78%) were men and 15 (22%) were women. The median age was 57 years old (range 34 to 95). RESULTS: Twenty-six (39%) patients had tumor in the floor of the mouth and 41 (61%), in the tongue. Using the criteria of the Union In ternationale Contre le Cancer (UICC), 1981, we classified 31 tumors (4 6%) as T1 lesions and 36 (54%) as T2 lesions. Thirty patients had a tu mor thickness less than or equal to 4 mm and 31 had a tumor thickness >4 mm. Thirty-three (49%) patients were treated with RA, and 34 patien ts (51%) were treated with RSOND. Seven (21%) patients of the RSOND gr oup had occult cervical metastasis. There were recurrences in 14 (42%) patients of the RA group and 8 (24%) patients of the RSOND group. The disease-free survival rates at 3.5 years for RA and RSOND patients we re 49%, and 72%, respectively. The impact of sex, age, site, cancer st age, and tumor thickness was assessed by the Mantel-Haenszel chi-squar e procedure. Later stage (P = 0.05) and increased tumor thickness (P = 0.005) were significantly associated with treatment failures. CONCLUS ION: Neck dissection remains mandatory ia the early stage of oral SCC, because of better survival rates compared to RA and the poor salvage rate. In particular, patients with tumor thickness >4 mm treated with RSOND had significant benefit on disease-free survival.