Metastasis to the lateral retropharyngeal lymph node, the so-called Rouviere node (RN), is rarely observed in carcinoma of the oral cavity, especially the tongue. The prognosis is extremely poor for those patients with metastasis to RN. Here we report a case of RN metastasis from squamous cell carcinoma of the tongue successfully treated with concurrent chemoradiotherapy (CCRT).
A 59-year-old man visited our facility with the complaint of contact pain of the tongue. A biopsy revealed that the lesion was squamous cell carcinoma (T2N1M0, stageⅢ). The patient underwent hemiglossectomy of the left side and selective neck dissection simultaneous with reconstruction using free radial forearm flap. Four months later, owing to the detection of a metastatic left submental lymph node, submental neck dissection of the left side and supraomohyoid neck dissection (SOHND) of the right side were performed. Postoperative concurrent chemoradiotherapy (CCRT) was initiated. The total dose of cisplatin was 200mg/m², and irradiation was performed at 2Gy per fraction, for a total of 60Gy. However, after the irradiation of 8Gy, metastasis of the left side of RN was detected on CT and PET-CT. Radiotherapy including the RN lesion was continued. One month after the CCRT, RN was not detected by CT and PET-CT. The treatment effect was complete response. During follow-up for 29 months, there was neither recurrence in the oral cavity nor RN metastasis after the CCRT.

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Previous studies have suggested that retrograde superselective intra-arterial chemoradiotherapy might be effective for cases of advanced oral cancer with cervical lymph nodes metastasis. Between February 2007 and November 2010, 20 oral cancer patients with cervical lymph node metastasis were treated with definitive retrograde superselective intraarterial chemoradiotherapy. Five patients had N1, 10 patients had N2b, and 5 patients had N2c disease. All patients were M0. Catheters were inserted into target arteries via superficial and occipital arteries, and the treatment consisted of superselective intra-arterial infusions（docetaxel, total 50-60mg/m², cisplatin, total 125-150mg/m²） and concurrent radiotherapy（total 50-60Gy） for 5-6 weeks. Primary site complete response was achieved, and patients underwent neck dissection 5-8 weeks after treatment. Pathological complete response in the cervical lymph node metastasis was obtained in 13（65％） of 20 patients. Thirteen patients were alive, and 7 patients died（6 patients died of distant metastasis, and 1 patient died of progression of cervical lesion during follow-up). We conclude that this treatment strategy was an effective regimen for oral cancer with cervical lymph node metastasis.

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Combination therapy with S-1, superselective intra-arterial infusion of carboplatin (CBDCA), and radiation therapy has been used to treat patients with oral cancer in our department since 2005 for the purpose of improving treatment results and the possibility of minimally invasive surgery. In this study, the histopathologic responses, outcomes and toxicities of this regimen as a preoperative treatment were retrospectively examined.
Thirty-five patients were treated with the above-described regimen from 2005 to 2012. The subjects consisted of 25 patients (21 men and 4 women) who were treated with this combination therapy as preoperative treatment. The average age of the patients was 61.2 years. The primary cancer sites were the tongue (13 cases), lower gingiva (4 cases), upper gingiva (3 cases), buccal mucosa (4 cases), and the floor of the mouth (1 case). Eleven patients showed T2 disease, 9 showed T3 disease, and 5 showed T4 disease. Five patients exhibited advanced stage Ⅱ, 10 exhibited stage Ⅲ, and 10 exhibited stage Ⅳa.
The histological response according to the Oboshi–Shimosato classification was grade IIb or higher in 24 cases (96.0％). The 5-year overall survival rate was 82.1％ and the 5-year disease-specific survival rate was 92.0％. Adverse events more severe than grade 2 consisted of anemia in 2 cases, leukocytopenia in 3 cases, thrombocytopenia in 1 case, mucositis in 22 cases, and weight loss in 3 cases. The treatment protocol was completed as planned in all patients. Our results suggest that it may be possible to perform minimally invasive surgery in some cases. Further investigation is needed to control neck recurrence and distant metastasis.

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During the 10-year period from 2004 to 2013, 150 cases of oral region squamous cell carcinoma were treated radically at our department; these cases were reviewed and clinically analyzed. The male-to-female ratio was 1.7：1 and the mean age was 65.3 years. Many cases were referrals from dental clinics (46.0％), whereas only 8.7％ of cases were direct presentations. The majority of patients (51.3％) were admitted within 3 months from the onset of symptoms. Pain was the most common symptom (39.3％), with the tongue being the most common site (54.7％). According to the TNM classification of UICC (2009), the patients were classified as follows: Tis, 3.3％; T1, 30.0％; T2, 37.3％; T3, 5.3％; T4, 24.0％; N0, 66.0％; N1, 15.3％; N2, 18.7％; N3, 0％; and M1, 0％. The patients were clinically staged as follows: Stage 0, 3.3％; Stage I, 28.0％; Stage II, 24.7％; Stage III, 12.7％; and Stage IV, 31.3％. The treatment methods were as follows: surgery, 60.0％; radiotherapy, 1.3％; surgery with chemotherapy, 4.0％; surgery with radiotherapy, 2.0％; chemotherapy with radiotherapy, 30.0％; and surgery with chemotherapy and radiotherapy, 2.7％. Kaplan-Meier survival curves indicated a 5-year survival rate of 84.1％.

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