Management of cervical metastases in advanced squamous cell carcinoma of the base of tongue.
OBJECTIVE
To clarify the role of neck dissection following primary radiotherapy for treatment of squamous cell carcinoma of the base of tongue.


METHODS
Case series.


METHODS
Academic, tertiary care medical center.


METHODS
A consecutive series of 45 patients with biopsy-proven squamous cell carcinoma of the base of tongue and cervical metastases treated with primary radiotherapy at The University of California, San Francisco, was examined. Patients with a prior history of neck irradiation, neck dissection, or head and neck cancer within 5 years were excluded.


METHODS
Overall survival and regional control.


RESULTS
Of the 45 patients treated with definitive radiotherapy, 25 (56%) achieved a complete response, 13 (29%) achieved a partial response, 4 (9%) were nonresponders, and 3 (7%) did not complete radiotherapy. Two thirds of the complete responders had N2 or N3 disease; 3 had recurrences in the neck, 1 of which was an isolated neck recurrence. Of the 13 partial responders, 5 had isolated persistence of disease, with 4 undergoing neck dissections. The only long-term survivors among the partial responders were those 4 who underwent a neck dissection. Overall survival was 50% at 3 years and 32% at 5 years. Regional control for complete responders was 84% at 5 years.


CONCLUSIONS
The low rate of isolated regional recurrence in patients with a complete response to radiotherapy supports the practice of surveillance alone in such patients. Patients with less than a complete response appear to benefit from prompt surgical salvage.
Pletcher
Steven D
SD
Department of Otolaryngology-Head and Neck Surgery, The University of California, San Francisco 94143, USA. spletcher@ohns.ucsf.edu
Kaplan
Michael J
MJ
Eisele
David W
DW
Singer
Mark I
MI
Quivey
Jeanne M
JM
Lee
Nancy
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000209:etiology / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects; D014062:Tongue Neoplasms / Q000473:pathology* / Q000532:radiotherapy*