Hicks W L, North J H, Loree T R, Maamoun S, Mullins A, Orner J B, Bakamjian V Y, Shedd D P
Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
Am J Otolaryngol. 1998 Jan-Feb;19(1):24-8. doi: 10.1016/s0196-0709(98)90061-8.
The treatment of squamous cell cancer of the oral tongue remains a challenging clinical problem. The efficacy of primary treatment with surgery versus radiation therapy for early stage disease and an adequate treatment paradigm for the clinically negative neck continues to be the subject of clinical debate. We have reviewed our experience in the treatment of oral tongue cancer with surgery as a single definitive treatment modality.
From 1971 to 1993, 79 patients with squamous cell carcinoma of the oral tongue were treated with surgery alone at Roswell Park Cancer Institute.
Clinically, 69% of the patients presented with stage I/II disease and 31% presented with stage III/IV. Survival by pathological stage I to IV was 89%, 95%, 76%, and 65%, respectively. Surgical therapy ranged from partial to total glossectomy. There were no patients with positive margins. Local recurrence was observed in 15% of patients with close margins (< 1 cm) and 9% of patients with adequate margins (> or = 1 cm). The incidence of pathological node positive (N+) disease was 6%, 36%, 50%, and 67% for T1, T2, T3, and T4 tumors, respectively. Twenty-five percent of patients undergoing elective neck dissection were pathological N+. All pathological confirmed nodal disease was at level I or II. Of the 43 patients with clinical N0 disease, 16% subsequently developed regional recurrence, all of which were surgically salvaged.
Locoregional control in patients with squamous cell carcinoma of the oral tongue can be achieved with primary surgical therapy. Adequate margins are crucial to local control. Salvage neck dissection may result in long-term survival for patients with regional relapse. Because of the high rate of occult disease (41%), we currently recommend prophylactic treatment of regional lymphatics for primary clinical disease of T2 or greater.
口腔舌鳞状细胞癌的治疗仍然是一个具有挑战性的临床问题。早期疾病采用手术与放射治疗作为初始治疗的疗效，以及针对临床阴性颈部的适当治疗模式，仍然是临床争论的主题。我们回顾了将手术作为单一确定性治疗方式治疗口腔舌癌的经验。
1971年至1993年，罗斯韦尔帕克癌症研究所对79例口腔舌鳞状细胞癌患者仅采用手术治疗。
临床上，69%的患者表现为I/II期疾病，31%表现为III/IV期。病理分期I至IV期的生存率分别为89%、95%、76%和65%。手术治疗范围从部分舌切除术到全舌切除术。切缘均为阴性。切缘接近（<1 cm）的患者局部复发率为15%，切缘足够（>或=1 cm）的患者局部复发率为9%。T1、T2、T3和T4肿瘤的病理淋巴结阳性（N+）疾病发生率分别为6%、36%、50%和67%。接受择区颈部清扫术的患者中有25%为病理N+。所有经病理证实的淋巴结疾病均位于I或II区。43例临床N0疾病患者中，16%随后出现区域复发，所有复发均通过手术挽救。
口腔舌鳞状细胞癌患者可通过初次手术治疗实现局部区域控制。足够的切缘对局部控制至关重要。挽救性颈部清扫术可能使区域复发患者获得长期生存。由于隐匿性疾病发生率高（41%），我们目前建议对T2及以上的原发性临床疾病进行区域淋巴结预防性治疗。
