Carcinoma of the tongue: factors affecting the results of surgical treatment

An anatomical perspective on clinicopathological characteristics and treatment outcomes of dorsal and ventrolateral tongue leukoplakia after carbon dioxide laser surgery

Background

The tongue has been identified as a high-risk site for malignant transformation of oral leukoplakia. The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of the dorsal and ventrolateral tongue leukoplakia.

Methods

Demographic data and pathological results of patients who underwent carbon dioxide laser surgery for tongue leukoplakia from 2002 to 2019 were retrospectively reviewed and analyzed statistically.

Results

Of the 111 patients enrolled, 80 were males and 31 females, with a mean age of 51.86 ± 11.84 years. The follow-up time was 3.74 ± 4.19 years. Fifteen patients had a postoperative recurrence (13.51%). Four (3.6%) patients developed malignant transformation. Annual transformation rate was 4.03%. There were no differences in the time to develop carcinoma (3.19 ± 1.94 vs. 3.51 ± 2.12 years, P = 0.83), overall cumulative malignant transformation rates (7.41% vs. 2.25%, P = 0.12), and annual transformation rates (2.32% vs. 0.64%, P = 0.099). The prevalence of the ventrolateral tongue leukoplakia was higher than that of the dorsal tongue leukoplakia (P < 0.001). The results of multivariate logistic regression analysis showed that the degree of pathology was the only independent prognostic factor related to postoperative malignant transformation (P = 0.045).

Conclusions

Dorsal tongue leukoplakia is not as frequently encountered clinically as ventrolateral tongue leukoplakia. The response of the dorsal tongue and ventrolateral tongue leukoplakia to laser therapy of are comparable in postoperative recurrence and postoperative malignant transformation. Clinicians should take a more aggressive attitude toward oral tongue leukoplakia with higher grade of dysplasia.

Decision Making in Advanced Cancer of the Head and Neck: Variation in the Views of Medical Specialists

Forty specialists were asked about their management of three theoretical patients with advanced cancer of the head and neck. Reasons for variation were explored by considering the influence of perceived aims of treatment (radical or palliative), together with a number of factors relating to the tumour, the lymph nodes, and the patients' personal circumstances. The perceived aim of treatment was the most important determinant as to treatment modality but, when chances of influencing survival were small, there was disagreement as to the appropriate aim and subjective value judgements became influential. More careful analysis of the initial decision-making process is needed if new clinical trials are to significantly affect clinical practices.

Lingual metastasis from renal cell carcinoma: a case report and literature review

Renal cell carcinoma (RCC) accounts for the 3% of all solid tumors. Despite continuous improvement in the therapy regimen, less has been achieved in terms of enabling an earlier diagnosis: the neoplasia usually reveals its presence at an advanced stage, obviously affecting prognosis. The most frequent sites of secondary disease are shown to be lungs (50–60%), bone (30–40%), liver (30–40%) and brain (5%); while the head and neck district seems to account for less than 1% of patients with primary kidney lesion. We report here the case of a 70-year old man who presented with acute renal failure due to abdominal recurrence of RCC 18 years post nephrectomy. After a few months of follow up without any systemic therapy due to the renal impairment, the patient presented a vascularized tongue lesion that was demonstrated to be a secondary localization of the RCC. This lesion has, therefore, been treated with microsphere embolization to stop the frequent bleeding and to lessen the unbearable concomitant symptoms it caused, such as dysphagia and pain. A tongue lesion that appears in a RCC patient should always be considered suspect and a multidisciplinary study should be conducted both to assess whether it is a metastasis or a primary new lesion and to understand which method should be selected, if necessary, to treat it (surgery, radiation or embolization). Lingual metastasis should be examined accurately not only because they seem to implicate a poor prognosis, but also because they carry a burden of symptoms that not only threatens patients' lives but also has a strong impact on their quality of life.

Carcinoma of the dorsum of the tongue

BACKGROUND

Squamous cell carcinoma (SCC) of the anterior two thirds of the tongue is the second most common oral cancer, with the lateral border being the most common location. Squamous cell carcinoma of the dorsum of the tongue is exceedingly rare and has been described in the past as a myth or misdiagnosis. The clinical diagnosis of SCC on the dorsum of the tongue is difficult because it may be mimicked by a wide variety of benign and premalignant lesions, including granular cell myoblastoma, erosive lichen planus, medial rhomboid glossitis, and amyloidosis. In this study we re-evaluate the entity of SCC of the dorsum of the tongue.

METHODS

We reviewed 5 large series of carcinoma of the tongue, which include accurate documentation of the topographic location of the carcinoma. We also describe 5 cases of SCC of the dorsum of the tongue from our own series of 99 patients with carcinoma of the tongue.

RESULTS

In all 6 series, carcinoma of the dorsum of the tongue was present in 3 to 5% of the carcinomas of the tongue.

CONCLUSION

Although rare, SCC of the dorsum of the tongue exists and may be mimicked by benign conditions, thus SCC should be suspected when diagnosing lesions of this area of the tongue.

Carcinoma of the oral tongue: a comparison of results and complications of treatment with radiotherapy and/or surgery

BACKGROUND

Oral tongue cancer may be treated primarily with radiotherapy or with surgery alone or combined with adjuvant radiotherapy; the choice between these two approaches is controversial.

METHODS

To evaluate the results of a shift in treatment policy in 1985 in favor of primary surgical treatment for carcinoma of the oral tongue, the results of radiotherapy (with or without neck dissection, 105 patients) were compared with those for surgery (with or without radiotherapy, 65 patients).

RESULTS

Local control rates were improved for T3 (p = .03) and 14 (p = .08) patients treated surgically but were similar for T1-T2 patients. Local-regional control and survival rates were not significantly different. The rate of severe complications was significantly higher (p = .01) for T3 patients treated with surgery, particularly in the subset of patients who received postoperative radiotherapy.

CONCLUSIONS

We generally recommend surgical treatment for T1-T2 patients with the addition of postoperative twice-a-day radiotherapy in selected cases. For selected T3-T4 patients we are investigating split-course twice-a-day preoperative radiotherapy in the hope that the extent of the surgical procedure, and hence the rate of severe complications, will be reduced.

Muscle damage and recovery in the rabbit tongue following photodynamic therapy with haematoporphyrin derivative

To study the effects of photodynamic therapy on the tissues of the tongue, 20 New Zealand White rabbits were injected intravenously with haematoporphyrin derivative. Their tongues and those of 2 controls were illuminated with 100 J/cm2 of red light from a copper vapour-pumped dye laser emitting light at 625 nm. The rabbits were sacrificed at intervals between 2 days and 12 weeks following treatment. Their tongues were examined histologically. Initially there was marked damage to mucosa, muscle and blood vessels. However, this healed by a mixture of regeneration and scarring.

Radical surgery for lingual cancer

The survival rates of 58 patients treated for squamous carcinoma of the tongue between 1972 and 1985 were evaluated. The overall 5-year survival rate was 41.6%; for stage I it was 61.8%; stage II 59.5%; and stage III, 27.7%. No patient survived for more than 2 years when their tumour was stage IV on presentation. A composite pull-through resection with radical neck dissection gave a 5-year survival rate of 50.7%, which was significantly (P less than 0.01) higher than the 13.8% achieved by other treatments, mainly local tumour excision combined with radiation therapy. The same trend in favour of radical surgery was also seen stage by stage. In 45% of the patients regional neck metastases (palpable in 35% and occult in 10%) were present and predicted a poor prognosis. Among T1-T2 cases the 5-year survival of 58.5% in the N0 group was significantly (P less than 0.01) higher than the 15.1% among those with nodal involvement. The location of the primary tumour did not affect the survival rates.

Cancer of the tongue and oral cavity in Auckland, New Zealand, 1970-86

This report comprises a retrospective review of the clinical data on 157 patients seen in the Auckland area having a diagnosis of cancer of the tongue, floor of the mouth, inferior alveolus, or buccal mucosa (retromolar area, vestibule of the mouth, and cheek mucosa) during 1970-86. One hundred patients were male, 95% were European, 85% were cigarette smokers, and 58% had a history of high alcohol intake. All primary tumours were squamous cell carcinomas, 50% were located in the tongue, 27% in the floor of the mouth, and 11.5% each in the buccal mucosa and inferior alveolus. The majority (60%) of patients with tongue cancer were clinically stage I at presentation while other intra-oral tumours were evenly distributed between stages I and IV. Surgical resection of the primary intra-oral lesion produced local control in 90% of stage I tumours, but this fell to below 70% in stage II-IV tumours. Most patients (82%) who recurred locally had positive or 'close' margins, and this rate of local tumour recurrence as a consequence of narrow margins did not decrease with the addition of adjuvant radiotherapy. Of those patients with stage I disease who received only treatment of the primary lesion, 20% later developed regional nodal disease which was controlled in more than half by neck dissection, but control was achieved only in 11% of patients treated with radiation. The presence of regional disease at presentation was associated with a poor prognosis. It is concluded that local control of inferior oral cavity tumours can be achieved if resection is accomplished with clear margins.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality after surgery for hypopharyngeal cancer

Results of 362 patients with squamous carcinoma of the hypopharynx are presented. The hospital mortality was 25 per cent for patients treated surgically. The mortality was increased by previous radiotherapy and poor general condition, and also depended on the method of pharyngeal repair: the mortality for visceral (stomach or colon) transposition was higher than that for repair by skin flaps. The chance of long term survival decreased with increasing N stage, and was also reduced for patients undergoing visceral repair compared with skin flap repair of the pharynx.

Primary procedure in carcinoma of the tongue: local resection versus combined local resection and radical neck dissection

Whether to perform local resection alone (LR) or to combine local resection with ipsilateral radical neck dissection (LR and RND) as primary treatment for carcinoma clinically confined to the tongue is controversial. To compare the outcomes of the two procedures, we reviewed the records of 502 patients treated for carcinoma of the tongue from 1949 to 1974, 128 of whom had no evidence of disease beyond the tongue. Immediate LR and RND was performed in 39; 16 (41%) had recurrences, and 14 (36%) died. On the other hand, 89 patients underwent LR alone; 43 (48%) had recurrences, and 29 (31%) died. All were followed for a minimum of 5 years or until their deaths. There was no statistical difference between the two procedures in recurrence or outcome. The two groups were compared with respect to tumor size according to the TNM classification, and no significant differences in recurrence or survival were apparent. LR alone appears to be adequate primary treatment for patients with no evidence of metastatic disease, provided close postoperative follow-up is observed. LR and RND may result in increased morbidity and certainly in disfigurement, and fails to improve prognosis or survival.

Carcinoma of the tongue in Norway and Wisconsin. I. Incidence and prognosis related to sex and age

The records of 503 patients with carcinoma of the tongue diagnosed between 1958 and 1972 were reviewed. The preponderance of tongue carcinoma among men was confirmed both in The Norwegian Radium Hospital (NRH) and the University of Wisconsin Hospitals (UW), but it was relatively more frequent among women in NRH and in UW than in southern Europe. More women had on presentation less advanced tumors at NRH than at UW. The incidence of tongue carcinoma in Norway increased steadily with age for both sexes. The sex ratio did not change in Norway such as in England, Canada and the United States. Tumor of the posterior one-third of the tongue was relatively infrequent in women both in NRH and UW, in agreement with reports from other countries. The length of survival was analysed and no significant sex difference was demonstrated. The younger patients had less advanced tumors and a better prognosis.