Improved survival in the treatment of squamous carcinoma of the oral tongue
During the past 15 years, newer trends in the management of oral tongue cancer have included increased use of elective neck dissection and mandible-sparing procedures, as well as a commitment to postoperative radiotherapy in patients with stage III and IV tumors. We retrospectively reviewed the records of 297 consecutive patients who underwent primary treatment of a squamous cancer of the oral tongue at our institution between 1978 and 1987 to determine the effects of the aforementioned therapeutic approaches on patients' survival. Determinate 5-year survival was 65% overall (82% for stages I and II, 49% for stages III and IV), which represents a significant improvement when compared with the survival rates we reported for the preceding 10-year period, despite the fact that the distribution of patients according to stage was about the same. Some type of lymphadenectomy was performed in 130 patients, 63 of whom underwent elective node dissection for T1 or T2 lesions. Forty-one percent of the latter had positive nodes, which upstaged the disease in a significant proportion of N0 patients. The number of positive nodes (more than two positive nodes) was a significant predictor of survival (p = 0.03). Postoperative radiotherapy was performed in 70% of patients with stage III or IV tumors. In this group of patients, the incidence of neck recurrence was reduced (13% versus 29% for patients who did not receive radiotherapy). The only long-term survivors among patients with stage IV tumors were those who received postoperative radiotherapy. Our results strongly suggest that the improvement in results is related to a more aggressive and effective treatment of the neck.