LONG-TERM RESULTS OF PRIMARY RADIOTHERAPY WITH WITHOUT NECK DISSECTION FOR SQUAMOUS-CELL CANCER OF THE BASE OF TONGUE/

Background. There are several management options for patients with squ amous cell cancer of the base of tongue. We have had an interest in us ing primary radiotherapy with or without neck dissection, in an effort to provide optimal oncologic as well as functional outcomes. Methods. From 1981 to 1995, 68 patients with primary squamous cell cancer of t he base of tongue were managed with primary radiotherapy, with neck di ssection added for those who were initially seen with palpable lymph n ode metastases. Ages ranged from 35 to 77 years (median age, 55 years) , There were 59 men and 9 women. T Stage distribution was: T1, 17; T2, 32; T3, 17; T4, 2, Fifty-eight patients (85%) were initially seen wit h nodal metastases. Initial treatment generally involved external-beam radiotherapy (EBRT) to the primary site and upper neck (54 Gy) and to the low neck (50 Gy). A 192-Ir brachytherapy boost (20-30 Gy) to the base of tongue was done about 3 weeks later, at the same anesthesia us ed for the neck dissection. All patients had temporary tracheostomy. F ollow-up ranged from 1 month to 151 months (median, 36 months). Nine p atients received neoadjuvant chemotherapy as pari of a larynx-presenta tion protocol. Results. Actuarial 5- and 10-year local control is 89% and 89%, distant metastasis free survival is 91% and 76%, disease-free survival is 80% and 67%, and overall survival is 86% and 52%, respect ively. Complications occurred in 16%. Conclusions: Our long term data clearly demonstrate that primary radiotherapy produces excellent oncol ogic outcomes. (C) 1998 John Wiley & Sons, Inc.