The Hannover experience: surgical treatment of tongue cancer--a clinical retrospective evaluation over a 30 years period

Horst Kokemueller, Majeed Rana, Jennifer Rublack, Andre Eckardt, Frank Tavassol, Paul Schumann, Daniel Lindhorst, Martin Ruecker, Nils-Claudius Gellrich, Horst Kokemueller, Majeed Rana, Jennifer Rublack, Andre Eckardt, Frank Tavassol, Paul Schumann, Daniel Lindhorst, Martin Ruecker, Nils-Claudius Gellrich

Abstract

Objectives: In this retrospective study, we present a clinical review of our experience with tongue cancer in order to obtain valid criteria for therapeutic decision-making.

Materials and methods: Between 1980 and 2009, a total of 341 patients with squamous cell carcinoma of the tongue were treated at our Department. The average follow-up was 5.2 years. 309 patients received surgical treatment, which was combined in nearly 10% with neoadjuvant and in nearly 20% with postoperative radio(chemo)therapy. 32 patients were excluded from surgery and received primary radiation.

Results: Local and regional failure occurred in 23.9% and 20.4%, leading to a total failure rate of 37.2% after an average duration of 1,6 years. N-Status, extracapsular spread and clear margins were identified as the dominant factors for survival, which was calculated with 54.5% after 5 years.

Conclusions: We recommend categorical bilateral neck dissection in order to reliably remove occult lymph node metastases. Adjuvant treatment modalities should be applied more frequently in controlled clinical trials and should generally be implemented in cases with unclear margins and lymphatic spread.

Clinical relevance: This study provides new treatment strategies for primary tumour disease and for tumour recurrence.

Figures

Figure 1
Figure 1
Survival of patients with surgical treatment and patients with primary radio(chemo)therapy (log rank p < 0.001).
Figure 2
Figure 2
Suvival of patients with different tumour sites (log rank p = 0.005).
Figure 3
Figure 3
Survival of patients with different tumour grading (log rank p = 0.004).
Figure 4
Figure 4
Survival of patients with different pT-Stage (log rank p < 0.001).
Figure 5
Figure 5
Survival of patients with different pN-Stage (log rank p < 0.001).
Figure 6
Figure 6
Survival of patients with different numbers of positive lymph nodes (log rank p < 0.001).
Figure 7
Figure 7
Survival of patients with and without extracapsular spread of positive lymph nodes (log rank p < 0.001).
Figure 8
Figure 8
Survival of patients with and without clear margins (log rank p < 0.001).
Figure 9
Figure 9
Suvival of patients with and without locoregional tumour recurrence (log rank p < 0.001).
Figure 10
Figure 10
Survival of patients with different treatment modalities for locoregional tumour recurrence (log rank p < 0.001).
Figure 11
Figure 11
Toung carcinoma defect of the right toung in a 64 year-old patient following resection of tumor. The reconstruction is planed with an anterolateral thigh flap (ALT-flap).
Figure 12
Figure 12
Harvested anterolateral thigh flap (ALT-flap) based on the perforator vessels of the descending branch of the lateral circumflex femoral artery for reconstruction of the right toung.
Figure 13
Figure 13
Reconstructed defect of the toung. Final result of the anterolateral thigh flap (ALT flap) after 6 month.

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