• Bradley A Schiff, Dianna B Roberts, Adel El-Naggar, Adam S Garden, and Jeffrey N Myers.
• Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA.
• Arch Otolaryngol. 2005 Oct 1; 131 (10): 874-8.

ObjectivesTo assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks.DesignRetrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years.SettingThe University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital.PatientsA total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence.InterventionsAll patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well.Main Outcome MeasuresClinical and pathological nodal status, type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates.ResultsFor clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P = .07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P = .24).ConclusionsSelective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.

18 keywords...

hide…