title: Carcinoma of the tongue base treated by transoral laser microsurgery, part two: Persistent, recurrent and second primary tumors.
abstract: OBJECTIVE
  To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tongue base.
  
  
  METHODS
  A two-center prospective case series analysis.
  
  
  METHODS
  Twenty-five patients with persistent, recurrent, or second primary squamous cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. Four (16%) patients with persistent disease at the primary site were considered TX. Eleven (44%) patients with recurrent disease were pathologically staged rT1 3/11, rT2 2/11, rT3 4/11, T4 1/11, and TX 1/11. Ten (40%) patients with second primary tumors were staged pT1, 4/10; pT2, 3/10; pT3, 2/10; and pT4, 1/10. Eight (32%) patients underwent neck dissection. Three (12%) patients received adjuvant radiotherapy. Pre- and post-treatment organ function was assessed using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale.
  
  
  RESULTS
  The mean follow-up period was 26 months. The 2-year Kaplan-Meier local control and locoregional control estimate was 69%. For those patients presenting with persistent/recurrent or second primary disease, the 2 year local control estimates were 75% and 68%, respectively. For all patients, the respective 2 and 5 year overall survival estimates were 54% and 26%. Two (8%) patients suffered postoperative hemorrhage. The average duration of hospitalization was 3.6 days. The median pretreatment and posttreatment FOSS stage was stage 2 and stage 3, respectively.
  
  
  CONCLUSIONS
  Transoral laser surgery is a rational and effective treatment in appropriately selected patients with persistent, recurrent, or second primary tongue base cancer. The low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida 32224, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Grant
authors.forename: John R
authors.initials: JR
authors.lastname: Salassa
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Pearson
authors.forename: William C
authors.initials: WC
authors.lastname: Perry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D014062:Tongue Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*