Experience of the Curie Institute in treatment of cancer of the mobile tongue: II. Management of the neck nodes.

Treatment of neck nodes of 602 patients with cancer of the mobile tongue was mainly surgical. Three-hundred-eighty-three (64%) were clinically N0, and 244 had elective neck dissection. Thirty-four percent (84/244) had occult metastasis. Thirteen percent (33/244) had major nodal involvement (greater than 3N + and/or extracapsular spread) and received postoperative radiotherapy. Twenty-one percent (7/33) recurred in the neck. Thirty-six percent (12/33) were alive, NED, at five years. Sixty-six percent (160/244) were N-, and 21% (51/244) had minimal nodal disease (less than or equal to 3N+) and did not receive postoperative radiotherapy; recurrence in neck was similar (7% and 14%) as well as the five-year survival (54% and 51%). Twenty-one patients had preoperative radiotherapy to the neck. Only one (5%) experienced recurrence of disease. Fifty had radiotherapy only. Seven (14%) failed in the neck. There were 219 patients who had clinically positive nodes and 120 who had radical neck dissection. One-hundred-one of these patients did not receive preoperative radiotherapy. Sixty-three percent (64/101) had nodal metastasis, and 27% (27/101) had major nodal involvement. In this group of patients, for the same degree of nodal involvement, postoperative recurrences in neck and the survival were similar to that of patients with clinically N0 neck, except for those with major nodal involvement. This latter group had a dismal five-year survival (12%). Nineteen had preoperative radiotherapy, and three (16%) had recurrence of disease in the neck. At present, patients with clinically N0 neck and small primary (less than or equal to 3 cm), who are therefore at low risk of failure at primary, receive brachytherapy and conservative neck dissection. Postoperative radiotherapy is given if major nodal metastasis exists. Those with larger primary (high risk of failure) receive neck irradiation only, since many will require combined resection at a later date. All patients with clinically positive nodes are treated preoperatively with 5500 rads before neck dissection.