Elective neck dissection versus watchful waiting in the management of early tongue cancers with node negative neck: our experience of 68 cases
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20214488Keywords:
Cancer, Occult, TongueAbstract
Background: Prognosis for tongue squamous cell carcinoma depends upon lymph node metastasis and the treatment plan depends upon the management of cervical lymph node metastasis.
Methods: A prospective analysis of early squamous cell carcinoma oral tongue was done February 2017 to February 2020 in previously untreated and biopsy proven patients with T1-2N0 cancer of tongue and patients with clinically negative nodes on the basis of palpation, ultrasound and computerized tomography (CT) and previously untreated and biopsy proven patients with T1-2N0 cancer of oral cavity. After proper work up, patients were divided into two groups. Group 1 (n=35) patients that underwent a surgical excision of primary tumor with 15mm safe margin and selective neck dissection (level I, II, III), group 2 (n=33) patients that underwent surgical excision of primary tumor with 15 mm safe margin and neck observation. All patients with tumor thickness ≥4 mm were included in this group.
Results: The study included 51 (75%) males and 17(25%) female patients. In this study, recurrence was significantly related to tumor thickness (p<0.05) i.e., >4 mm tumor thickness showed significantly higher local recurrence and nodal recurrences. Also, a significantly higher relationship was seen between nodal recurrence and postoperative close surgical margins (p<0.05).
Conclusions: Elective neck dissection becomes necessary in patients with T2N0 tumors and tumor thickness of >4 mm as frequency of occult metastasis and recurrence is more in these patients.
References
Perkin D, Whelan S, Ferlay J. Cancer incidence in five continents. IARC Sci Pub. 1995;155:1-190.
Lydiatt D, Robbins K, Byers R. Treatment of stage I and II oral tongue cancer. Head Neck Surg. 1993;15:308-12.
Tateda M, Shiga K, Saijo S. A clinical study of oral tongue cancer. Tohoku J Exp Med. 2000;192:49-59.
Ganly I, Patel S, Shah J. Early-stage squamous cell cancer of the oral tongue-clinic-pathologic features affecting outcome. Cancer. 2012;118:101-11.
Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck. 2005;27:1080-91.
Teichgraeber J, Clairmont A. The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: treatment rationale. Head Neck Surg. 1984;7:15-21.
Jalisi S. Management of the clinically negative neck in early squamous cell carcinoma of the oral cavity. Otolaryngol Clin North Am. 2005;38:37-46.
Jones K, Lodge-Rigal R, Reddick R. Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity. Arch Otolaryngol Head Neck Surg. 1992;118:483-5.
Dias FL, Kligerman J, Matos de Sá G. Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth. Otolaryngol Head Neck Surg. 2001;125:23-9.
Duvvuri U, Simental AA, D’Angelo G. Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx. Laryngoscope. 2004;114:2228-34.
Amaral TM, Da Silva Freire AR, Carvalho AL. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. Oral Oncol. 2004;40:780-6.
Feng Z, Li JN, Li CZ. Elective neck dissection versus observation in the management of early tongue carcinoma with clinically node-negative neck: a retrospective study of 229 cases. J Craniomaxillofac Surg. 2014;42:806-10.
Iype EM, Sebastian P, Mathew A. The role of selective neck dissection (I-III) in the treatment of node negative (N0) neck in oral cancer. Oral Oncol. 2008;44:1134-8.
Huang SF, Kang CJ, Lin CY. Neck treatment of patients with early-stage oral tongue cancer: comparison between observation, supra-omohyoid dissection, and extended dissection. Cancer. 2008;112:1066-75.
Yuen AP, Ho CM, Chow TL. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck. 2009;31:765-72.
Whitehurst JO, Droulias CA. Surgical treatment of squamous cell carcinoma of the oral tongue. Arch Otolaryngol. 1977;103:212-5.
Johnson JT, Leipzig B, Cummings CW. Management of TI carcinoma of the anterior aspect of the tongue. Arch Otolaryngol. 1980;106:249-51.
Ho CM, Lam KH, Wei WI. Occult lymph node metastases in small oral tongue cancers. Head Neck. 1992;14:359-63.
Van den Brekel MWM, Van der Waal I, Meijer CJ. The incidence of micro-metastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope. 1996;106:987-91.
Cunningham MJ, Johnson JT, Myers EN. Cervical lymph node metastasis after local excision of early squamous cell carcinoma of the oral cavity. Am J Surg. 1986;152:361-6.
Spiro RH, Strong EW. Surgical treatment of cancer of tongue. Surg Clin North Am. 1974;24:75-9.
Lim YC, Ahn JY, Koo BS. Occult lymph node metastasis in early oral tongue squamous cell carcinoma. Korean J Otolaryngol Head Neck Surg. 2006;49:407‐10.
Yii NW, Patel SG, Rhys‐Evans PH. Management of the N0 neck in early cancer of the oral tongue. Clin Otolaryngol Allied Sci. 1999;24:75‐9.
Haddadin KJ, Soutar DS, Oliver RJ. Improved survival for patients with clinically T1/T2 N0 tongue tumors undergoing a prophylactic neck dissection. Head neck. 1999;21:517-25.
De Bondt RB, Nelemans PJ, Hofman PA. Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol. 2007;64:266e272.
Yuen AP, Ho CM, Chow TL. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck. 2009;31:765e772.
Faisal M, Abu Bakar M, Sarwar A. Depth of invasion as a predictor of cervical nodal metastasis and local recurrence in early-stage squamous cell carcinoma of oral tongue (ESSCOT). PLoS ONE. 2018;13(8):e0202632.
Davidson BJ, Root WA, Trock BJ. Age and survival from squamous cell carcinoma of the oral tongue. Head Neck. 2001;23:273‐9.
Hakeem AH, Pradhan SA, Kannan R. Clinical outcome of surgical treatment of T1-2 N0 squamous cell carcinoma of oral tongue with observation for the neck: Analysis of 176 cases. Ann Maxillofac Surg. 2016;6:235-40.
Kshirsagar P, Manerikar KA. Relation between the depth of tumor and neck node metastasis in early carcinoma of tongue. Int Surg J. 2018;5:2154-8.
O’Brien CJ, Lauer CS, Fredricks S. Tumor thickness influences prognosis of T1 and T2 oral cavity cancer-But what thickness? Head Neck. 2003;25:937‐45.
Shintani S, Yoshihama Y, Ueyama Y. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxillofac Surg. 2001;30:139‐43.
