Functional aspects of cancer of the base of the tongue

doi:10.1016/0002-9610(67)90003-7

The American Journal of Surgery

Volume 114, Issue 4, October 1967, Pages 489-492

https://doi.org/10.1016/0002-9610(67)90003-7 Get rights and content

Abstract

It is our impression that surgery can be of use in the control of cancer of the base of the tongue after thorough evaluation of the patient by both surgeon and radiotherapist.

Good results can be obtained if an attempt is made to reconstruct functional anatomy and physiology.

References (1)

H. Rouviere
Anatomy of the Human Lymphatic System

Cited by (8)

The management of patients with carcinoma of the tongue
1993, British Journal of Oral and Maxillofacial Surgery
Surgery, radiotherapy or the combination of these two modalities remains the accepted treatment for squamous carcinoma of the tongue. In the 10-year period between 1982 and 1992, 121 patients presented to the combined Maxillofacial/Radiation Oncology Clinic, Royal Infirmary, Edinburgh with carcinoma of the tongue.
The majority of T1 tumours have been treated by surgical excision, almost equal numbers of T2 tumours were treated by surgery or radiotherapy, T3 and T4 tumours without evidence of nodal disease were treated by radiotherapy. Patients presenting with established nodal disease or involvement of bone were treated primarily by surgery.
The patients presenting with T3 and T4 tumours were combined to produce a more realistic figure for statistical analysis.
The actual 5-year survival rates for patients presenting from 1982 to 1987 for T1, T2 and T3/4 tumours are 83%, 63% and 0% respectively. Five year actuarial survival rates for patients from 1987 to 1992 are 89%, 69% and 47%.
In the absence of nodal disease in the retrospective group, T1, T2 and T3/4 carcinomas of the tongue have actual 5-year survival rates of 93%, 87% and 0% respectively.
Patients who present with or later develop nodal disease have a poorer prognosis with survival rates of 33%, 33% and 0% for T1, T2 and T3/4 tumours.
The size of the primary tumour did not significantly affect the five year survival rate when nodal disease was present.
Brachytherapy as part of the definitive management of squamous cancer of the base of tongue
1989, International Journal of Radiation Oncology, Biology, Physics
Between 1981 and 1986, 17 patients were treated at the Department of Radiation Oncology at the Memorial Sloan-Kettering Cancer Center with squamous cancer of the base of the tongue whose definitive treatment included brachytherapy. The patient sample consisted of 14 men and 3 women with age range of 35 to 71 years (median = 58). There were four patients with T1 lesions, six with T2, six with T3, and one with T4. In general, treatment consisted of 5000–5400 cGy with external beam radiation and 2000–3000 cGy boost to the base of tongue via an Ir-192 implant using afterloading catheters. Necks were managed with elective radiation alone in the NO group (n = 5) or with radiation plus neck dissection in the N+ group (n = 12). Five patients who would have required laryngectomy had they undergone primary surgery received neoadjuvant chemotherapy followed by external beam and implant as part of a larynx preservation study that was being done at our institution (4-T3, 1-T2). The range of follow-up is 8 to 59 months, with median follow-up of 24 months. No patients have been lost to follow-up. Crude local control by T-Stage are as follows: $T l- 44, T 2- 56, T 3- 56, T 4- 11$ . Actuarial local control at 24 months is 87%. There have been no neck failures. There have been five patients who had soft tissue ulceration (STU) and one patient who had osteoradionecrosis (ORN). All soft tissue ulceration patients have been successfully managed conservatively. The patient with osteoradionecrosis is currently being managed. In 4 of these 6 cases, the implant was the initial therapeutic intervention and the entire tumor bed was implanted. On the other hand, when external beam was the initial treatment, the boost was administered to the smaller volume of residual disease. Overall, 4 of 7 patients who had implant first developed either soft tissue ulceration or osteoradionecrosis, as opposed to 2 of 10 patients who had implant after external beam and/or chemotherapy. The numbers are too small to be statistically significant, but our current policy is to perform brachytherapy after the external beam. In addition, all those with either soft tissue ulceration or osteoradionecrosis were implanted with a non-looping technique. Overall, 6 of 12 patients treated with a non-looping technique developed an injury, whereas none of the five treated with a looping technique has developed one. The probability of local control at 24 months is 87%. There have been only two cancer related deaths, and the survival at 2 years is also 87%. Our ongoing experience suggests that radiation with external beam and brachytherapy is a successful treatment for selected base of tongue tumors.
Reconstruction in patients with oral and pharyngeal cancer
1977, Current Problems in Surgery
Glossectomy rehabilitation by mandibular tongue prosthesis
1972, The Journal of Prosthetic Dentistry
In the rehabilitation of patients following complete glossectomy, the early placement of an obturator to assist in deglutition and articulation has proved to be effective. The tongue is not absolutely necessary in the production of speech. In all glossectomy patients, though, there seems to be a reluctance to try to speak or take oral fluids after the operation. Tongue prostheses constructed in conjunction with mandibular removable partial dentures, with the tongue portion in an elevated position, give patients the additional help needed to overcome this initial reluctance. The patients are able to quickly regain their speech and swallowing abilities. A tongue prosthesis can speed the recovery of patients and return them to society to enjoy a nearly normal diet and speak understandably without a tongue.
Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap
2008, Archives of Otolaryngology - Head and Neck Surgery
T stage and functional outcome in oral and oropharyngeal cancer patients
1996, Head and Neck

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^☆: Presented at the Thirteenth Annual Meeting of the Society of Head and Neck Surgeons, New York, New York, April 17–19, 1967.

¹: From the Department of Surgery, University of California College of Medicine, Irvine, California, and St. John's Hospital, Santa Monica, California.

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Functional aspects of cancer of the base of the tongue☆

Abstract

Anatomy of the Human Lymphatic System