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From the Department of Surgery, Division of Otorhinolaryngology, The University of Hong Kong, Hong Kong,
SAR, China.
It is common practice to treat stage I-II carcinomas with the neck and oral cavity is advised, and elective neck dissection
surgery alone and stage III-IV carcinomas with combined is unnecessary.
surgery and radiotherapy. Over 90% of treatment failures Management of cancer of the oral tongue is still contro-
are caused by local or regional lymph node recurrences.1-3 versial in many aspects and will change over time with
Good results largely rely on a surgical management protocol better understanding of the cancer and with advances in
based on sound principles. technology. The current management protocol in the De-
Carcinoma of the tongue has a high propensity for me- partment of Surgery of the University of Hong Kong, Queen
tastasis to regional lymph nodes even in its early stage. Mary Hospital, is summarized below:
Subclinical nodal metastasis for T1 and T2 oral tongue
carcinoma was found to be 36% in a study of whole organ Stage I-II oral tongue carcinoma:
serial sectioning of elective neck dissection specimens of ● Tumor thickness up to 3 mm: partial glossectomy alone
the clinically N0 neck.4 Although preoperative radiological ● Tumor thickness 4 to 9 mm: partial glossectomy ! elec-
screening, including computed tomography, magnetic reso- tive ipsilateral level I-V functional neck dissection
nance imaging, or ultrasound guided aspiration cytology, is ● Tumor thickness !1 cm: partial glossectomy " postop-
currently our routine protocol for evaluation, these radio- erative radiotherapy of oral cavity and neck
logical screening methods are useful but not adequate for
detecting micrometastasis. Elective neck dissection has Stage III-IV oral tongue carcinoma:
been shown to improve survival by reducing lymph node- Partial glossectomy
related mortality5 ● radical (or modified radical) neck dissection of N" neck
Among all the tumor parameters and predictive models ● ipsilateral selective level I-III neck dissection for N0 neck
being evaluated, tumor thickness has been shown to be the if free flap is used for reconstruction
most useful at predicting subclinical nodal metastasis, local ● ipsilateral modified neck dissection for N0 neck if pec-
recurrence, and survival.6 Management of the N0 neck in toralis major myocutaneous flap is used for reconstruction
early-stage cancer of the oral tongue is based on tumor thick- ● postoperative radiotherapy of oral cavity and neck
ness. Patients with tumors up to 3 mm thick have 8% subclin-
ical nodal metastasis, 0% local recurrence, and 100% 5-year Postoperative radiotherapy is also indicated in stage I-II
actuarial disease-free survival; elective neck dissection is not carcinoma after pathologic evaluation of surgical spec-
indicated. Patients with tumors that are 4 to 9 mm thick have imens with the following findings:
44% subclinical nodal metastasis, 7% local recurrence, and 1. positive resection margin
76% 5-year actuarial disease-free survival; these patients will 2. perineural spread
require close postoperative follow-up surveillance with ultra- 3. extracapsular spread of subclinical nodal metastasis
sound. For those patients for whom follow-up visits are not 4. multiple subclinical nodal metastasis
feasible or who are unreliable for close follow-up surveillance
protocol, elective neck dissection is advisable. Patients with Carcinoma of the base of the tongue:
tumors that are at least 10 mm thick have 53% subclinical ● Stage I-II: radiotherapy
nodal metastasis, 24% local recurrence, and 66% 5-year actu-
● Stage III-IV: concomitant regional or systemic chemo-
arial disease-free survival. These patients will be treated as
therapy " radiotherapy
advanced-stage carcinoma, with a high risk of both local and
regional recurrence. Postoperative radiotherapy covering both Advanced inoperable carcinoma of the tongue:
● without distant metastasis: concomitant regional or sys-
Address reprint requests and correspondence: Anthony Po-Wing
Yuen, FHKAM (ORL), Department of Surgery, The University of Hong
temic chemotherapy " radiotherapy
Kong Medical Center, Queen Mary Hospital, 102 Pokfulam Road, Hong ● with distant metastasis: palliative symptomatic man-
Kong, SAR, China. agement
1043-1810/$ -see front matter © 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.otot.2004.04.002
Yuen Cancer of the Tongue 235
Figure 5 The whole tongue is pulled down into the neck for
resection with the ultrasonic coagulating scissors of a large tumor.
A 2-cm resection margin is outlined. ND, neck dissection speci- Figure 7 Primary closure with interrupted sutures after partial
men. glossectomy of small tumor.
Yuen Cancer of the Tongue 237