COMBINED SURGERY AND POSTOPERATIVE RADIOTHERAPY FOR CARCINOMA OF THE BASE OF TONGUE - ANALYSIS OF TREATMENT OUTCOME AND PROGNOSTIC VALUE OFMARGIN STATUS

Background. Choice of treatment for base of tongue carcinoma is contro versial, with options including surgery alone, radiotherapy alone, or multimodality treatment. Given the highly aggressive nature of these t umors, it has been our institutional policy to manage this disease wit h combined partial glossectomy (with attempt to avoid laryngectomy if possible) with planned postoperative radiotherapy (RT). We report on o ur institutional experience with this approach. Methods. A retrospecti ve review of the charts of 17 patients with primary base of tongue squ amous cell carcinoma treated with surgery and postoperative RT was per formed. Patients treated with chemotherapy as part of their management were excluded. All patients underwent partial, hemi-, or subtotal glo ssectomy; 15/17 patients underwent ipsilateral radical or modified rad ical neck dissection. All patients received comprehensive postoperativ e RT (median dose 6000 cGy; range 5040-6920 cGy). Stage distribution w as as follows: stage I, 2; stage II, 3; stage III, 2; stage IV, 10. Po sitive margins for invasive carcinoma were found in 9/17 patients. Med ian follow-up of surviving patients is 46 months; median follow-up for all patients is 31 months. Results. For the entire group of patients, the actuarial 3-year local-regional control rate was 68%. The actuari al a-year overall survival was 46%. The local-regional control rate wa s 83% for patients with stage I-III disease versus 50% for stage IV di sease. There were no local failures among eight patients with negative margins (local control 100%) compared with an actuarial local control rate of 36% among patients with positive margins (p = .03). Survival, disease-specific survival, and locoregional control were also highly correlated with margin status (p = .003). Late major complications inc luded 5/17 patients requiring permanent G-tubes and/or tracheostomy to prevent aspiration. Conclusions. Surgery plus postoperative RT is an intensive treatment for carcinoma of the base of tongue which offers h igh locoregional control in patients in whom negative margins are achi eved. Positive margins indicate a high risk of locoregional and system ic failure, and these patients should be considered for innovative cli nical trials after surgery. (C) 1997 John Wiley & Sons, Inc.