LONG-TERM REGIONAL CONTROL AFTER RADIATION-THERAPY AND NECK DISSECTION FOR BASE OF TONGUE CARCINOMA

Purpose: Minimal literature exists with 10-year data on neck control i n advanced head and neck cancer. The purpose of this study is to deter mine long-term regional control for base of tongue carcinoma patients treated with primary radiation therapy plus neck dissection. Methods a nd Materials: Between 1981-1996, primary radiation therapy was used to treat 68 patients with squamous cell carcinoma of the base of tongue. Neck dissection was added for those who presented with palpable lymph node metastases. The T-stage distribution was T1, 17; T2, 32; T3, 17; and T4, 2. The N-stage distribution was N0, 10; N1, 24; N2a, 6; N2b, 11, N2c, 8; N3, 7; and Nx, 2. Ages ranged from 35 to 77 (median 55 yea rs) among the 59 males and nine females. Therapy generally consisted o f initial external beam irradiation to the primary site (54 Gy) and ne ck (50 Gy). Clinically positive necks were boosted to 60 Gy with exter nal beam irradiation, Three weeks later, the base of tongue was booste d with an Ir-192 interstitial implant (20-30 Gy). A neck dissection wa s done at the same anesthesia for those who presented with clinically positive necks, even if a complete clinical neck response was achieved with external beam irradiation. Neoadjuvant cisplatin-based chemother apy was administered to nine patients who would have required a total laryngectomy if their primary tumors had been surgically managed. The median follow-up was 36 months with a range from 1 to 151 months. Elev en patients were followed for over 8 years. No patients were lost to f ollow-up. Results: Actuarial 5- and 10-year neck control was 96% overa ll, 86% after radiation alone, and 100% after radiation plus neck diss ection. Pathologically negative neck specimens were observed in 70% of necks dissected after external beam irradiation. The remaining 30% of dissected necks were pathologically positive, These specimens contain ed multiple positive nodes in 83% despite a 56% overall complete clini cal neck response rate to irradiation. Regional failure occurred in on ly two patients, neither of whom underwent adjuvant neck dissection. S ymptomatic neck fibrosis (RTOG grade 3) was not observed. Actuarial 5- and 10-year local central was 88% and 88%, disease-free survival was 80% and 67%, and overall survival was 86% and 52%. Conclusion: For bas e of tongue cancer, most patients tan obtain long-term regional contro l with no severe complications after definitive radiation therapy, plu s neck dissection for those who present with lymphadenopathy. Complete clinical regression of palpable neck metastases after irradiation poo rly correlates with pathologic outcome. Our current policy is to inclu de neck dissection at the time of implantation for patients who presen t with palpable neck metastases. We realize that this therapeutic appr oach may overtreat some patients, but we are reluctant to change our p olicy in light of these excellent outcomes. (C) 1997 Elsevier Science Inc.