Abstract
The five-year survival rate for carcinoma of the tongue usually ranges from 40 to 60 percent. Recently, it was reported that an excellent result was obtained with intra-tissue radium needle therapy, as conducted at the National Cancer Center in Tokyo. With this therapy the five-year survival rate was 60 percent. Because of the minimum disturbance in function, this therapeutic approach is probably the best available. It requires, however, special facilities which many hospitals do not have. The present paper is a discussion of treatments for carcinoma of the tongue in the absence of the facility for intra-tissue radium needle therapy.
For the 34 patients treated at our hospital between 1960 and 1970, different approaches were applied on a patient to patient basis. The five year survival rate was 44 percent. The cause of death in 19 was local recurrence in 11 and cervical metastasis in 6. Thus, there was a necessity for improvement in managing the primary lesion and the cervical lymph nodes.
Since 1971 we have been using a program which includes preoperative radiation and local infusion chemotherapy followed by extensive removal of the primary lesion and radical neck dissection. In some patients, the basic program was modified according to their condition. The five-year survival rate for 40 patients was 65 percent. Only one patient died of local recurrence and three died of cervical metastasis.
A retrospective study and histological examination of the neck specimens appears to justify the following conclusion:
(1) For T1 and T2 lesions limited within one half side of the tongue body, radiation and local infusion chemotherapy without surgical removal is frequently successful. Neck dissection in an attempt at prevention is not required.
(2) For a T2 lesion extending beyond one half side of the tongue body, and the T3 lesion, treatments should include preoperative radiation and local chemotherapy followed by extensive surgical removal and radical neck dissection. Reconstructive procedures are required to minimize functional disorders.
