SURGERY AS A SINGLE MODALITY THERAPY FOR SQUAMOUS-CELL CARCINOMA OF THE ORAL TONGUE

Purpose: The treatment of squamous cell cancer of the oral tongue rema ins a challenging clinical problem. The efficacy of primary treatment with surgery versus radiation therapy for early stage disease and an a dequate treatment paradigm for the clinically negative neck continues to be the subject of clinical debate. We have reviewed our experience in the treatment of oral tongue cancer with surgery as a single defini tive treatment modality. Patients and Methods: From 1971 to 1993, 79 p atients with squamous cell carcinoma of the oral tongue were treated w ith surgery alone at Roswell Park Cancer Institute. Results: Clinicall y, 69% of the patients presented with stage I/II disease and 31% prese nted with stage III/IV. Survival by pathological stage I to IV was 89% , 95%, 76%, and 65%, respectively. Surgical therapy ranged from partia l to total glossectomy. There were no patients with positive margins. Local recurrence was observed in 15% of patients with close margins (< 1 cm) and 9% of patients with adequate margins (greater than or equal to 1 cm). The incidence of pathological node positive (N+) disease was 6%, 36%, 50%, and 67% for T1, T2, T3, and T4 tumors, respectively. Tw enty-five percent of patients undergoing elective neck dissection were pathological N+. All pathological confirmed nodal disease was at leve l I or II. Of the 43 patients with clinical NO disease, 16% subsequent ly developed regional recurrence, all of which were surgically salvage d. Conclusion: Locoregional control in patients with squamous cell car cinoma of the oral tongue can be achieved with primary surgical therap y. Adequate margins are crucial to local control. Salvage neck dissect ion may result in long-term survival for patients with regional relaps e. Because of the high rate of occult disease (41%), we currently reco mmend prophylactic treatment of regional lymphatics for primary clinic al disease of T2 or greater. Copyright (C) 1998 by W.B. Saunders Compa ny.