Machtay M, Perch S, Markiewicz D, Thaler E, Chalian A, Goldberg A, Kligerman M, Weinstein G
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Head Neck. 1997 Sep;19(6):494-9. doi: 10.1002/(sici)1097-0347(199709)19:6<494::aid-hed6>3.0.co;2-u.
Choice of treatment for base of tongue carcinoma is controversial, with options including surgery alone, radiotherapy alone, or multimodality treatment. Given the highly aggressive nature of these tumors, it has been our institutional policy to manage this disease with combined partial glossectomy (with attempt to avoid laryngectomy if possible) with planned postoperative radiotherapy (RT). We reported on our institutional experience with this approach.
A retrospective review of the charts of 17 patients with primary base of tongue squamous cell carcinoma treated with surgery and postoperative RT was performed. Patients treated with chemotherapy as part of their management were excluded. All patients underwent partial, hemi-, or subtotal glossectomy; 15/17 patients underwent ipsilateral radical or modified radical neck dissection. All patients received comprehensive postoperative RT (median dose 6000 cGy; range 5040-6920 cGy). Stage distribution was as follows: stage I, 2; stage II, 3; stage III, 2; stage IV, 10. Positive margins for invasive carcinoma were found in 9/17 patients. Median follow-up of surviving patients is 46 months; median follow-up for all patients is 31 months.
For the entire group of patients, the actuarial 3-year local-regional control rate was 68%. The actuarial 3-year overall survival rate was 46%. The local-regional control rate was 83% for patients with stage I-III disease versus 50% for stage IV disease. There were no local failures among eight patients with negative margins (local control 100%) compared with an actuarial local control rate of 36% among patients with positive margins (p = .03). Survival, disease-specific survival, and locoregional control were also highly correlated with margin status (p = .003). Late major complications included 5/17 patients requiring permanent G-tubes and/or tracheostomy to prevent aspiration.
Surgery plus postoperative RT is an intensive treatment for carcinoma of the base of tongue which offers high locoregional control in patients in whom negative margins are achieved. Positive margins indicate a high risk of locoregional and systemic failure, and these patients should be considered for innovative clinical trials after surgery.
舌根癌的治疗方案存在争议，选择包括单纯手术、单纯放疗或多模式治疗。鉴于这些肿瘤具有高度侵袭性，我们机构的政策是采用联合部分舌切除术（尽可能避免喉切除术）并计划术后放疗（RT）来治疗这种疾病。我们报告了我们机构采用这种方法的经验。
对17例接受手术和术后放疗的原发性舌根鳞状细胞癌患者的病历进行回顾性分析。排除接受化疗作为治疗一部分的患者。所有患者均接受部分、半或次全舌切除术；15/17例患者接受同侧根治性或改良根治性颈清扫术。所有患者均接受全面的术后放疗（中位剂量6000 cGy；范围5040 - 6920 cGy）。分期分布如下：I期2例；II期3例；III期2例；IV期10例。17例患者中有9例侵袭性癌切缘阳性。存活患者的中位随访时间为46个月；所有患者的中位随访时间为31个月。
对于整个患者组，3年精算局部区域控制率为68%。3年精算总生存率为46%。I - III期疾病患者的局部区域控制率为83%，而IV期疾病患者为50%。8例切缘阴性患者无局部复发（局部控制率100%），而切缘阳性患者的精算局部控制率为36%（p = 0.03）。生存、疾病特异性生存和局部区域控制也与切缘状态高度相关（p = 0.003）。晚期主要并发症包括5/17例患者需要永久性胃造瘘管和/或气管造口术以防止误吸。
手术加术后放疗是治疗舌根癌的一种强化治疗方法，对于切缘阴性的患者可提供较高的局部区域控制率。切缘阳性表明局部区域和全身失败的风险较高，这些患者术后应考虑参加创新性临床试验。
