Carcinoma of the tongue base treated by transoral laser microsurgery, part one: Untreated tumors, a prospective analysis of oncologic and functional outcomes.
OBJECTIVE
To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the management of untreated primary carcinoma of the tongue base.


METHODS
A two center prospective case series analysis.


METHODS
Fifty-nine patients with pathologically confirmed squamous cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. The pathological T stage distribution was: T1, 16; T2, 23; T3, 12 and T4, 8. Thirty-six patients presented with stage IV disease, 12 with stage III, 7 with stage II and 4 with stage I disease. Neck dissections were performed in 49 patients (83%). Twenty-eight patients (47%) underwent adjuvant radiotherapy. End points analyzed were local control, loco regional control, disease specific survival, and overall survival. Organ function was assessed before and after treatment using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS) staging system.


RESULTS
The mean follow up for all patients was 31 months. The 2 and 5-year Kaplan-Meier estimates were: local control, both 90%; loco-regional control, both 88%; recurrence free survival, both 84% and overall survival 91% and 69% respectively. For all patients the median stay in hospital was 4 days. The median length of hospital visit for TLM alone was 2.5 days and 4 days for TLM with neck dissection. Three patients (5%) suffered minor post-operative hemorrhage. The median pre-operative FOSS stage was 0 (normal function.) The median post-operative FOSS stage was stage 1 (Normal function with episodic or daily symptoms of dysphagia.) There were no clinically significant changes in communication function after treatment.


CONCLUSIONS
Transoral laser surgery is a safe and effective treatment for select early and advanced previously untreated squamous cell cancer of the tongue base. In addition, the low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.
Grant
David G
DG
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida 32224, USA.
Salassa
John R
JR
Hinni
Michael L
ML
Pearson
Bruce W
BW
Perry
William C
WC
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D014062:Tongue Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D014140:Tracheotomy; D016896:Treatment Outcome