title: Long-term regional control and survival in patients with "low-risk," early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness.
abstract: BACKGROUND
  The objectives of this study were to determine the incidence of locoregional failure in patients with low-risk, early stage oral tongue squamous cell cancer (OTSCC) who undergo partial glossectomy and ipsilateral elective neck dissection without receiving postoperative radiation.
  
  
  METHODS
  A combined database of patients with OTSCC who received treatment at Memorial Sloan-Kettering Cancer Center and Princess Margaret Cancer Center from 1985 to 2005 was established. In total, 164 patients with pathologic T1-T2N0 OTSCC who underwent partial glossectomy and ipsilateral elective neck dissection without postoperative radiation were identified. Patient-related, tumor-related, and treatment-related characteristics were recorded. Local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were calculated by the Kaplan-Meier method. Predictors of outcome were analyzed by univariate and multivariate analysis.
  
  
  RESULTS
  At a median follow-up of 66 months (range 1-171 months), the 5-year rates of local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were 89%, 79.9%, and 85.6%, respectively. Regional recurrence was ipsilateral in 61% of patients and contralateral in 39% of patients. The regional recurrence rate was 5.7% for tumors <4 mm and 24% for tumors ≥ 4 mm. Multivariate analysis indicated that tumor thickness was the only independent predictor of neck failure (regional recurrence-free survival, 94% vs 72% [P = .02] for tumors <4 mm vs ≥ 4 mm, respectively). Patients who developed recurrence in the neck had a significantly poorer disease-specific survival compared with those who did not (33% vs 97%; P < .0001).
  
  
  CONCLUSIONS
  Patients with low-risk, pathologic T1-T2N0 OTSCC had a greater than expected rate of neck failure, with contralateral recurrence accounting for close to 40% of recurrences. Failure occurred predominantly in patients who had primary tumors that were ≥ 4 mm thick.
authors.affiliation: Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. ganlyi@mskcc.org
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Diane L
authors.initials: DL
authors.lastname: Carlson
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005927:Glossectomy / Q000379:methods*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011184:Postoperative Period; D011379:Prognosis; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*