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Radiation Unnecessary for Some Patients With Tongue Squamous Cell Carcinoma: Presented at IAOO

By Louise Gagnon

TORONTO -- July 10, 2009 -- Patients with early stage oral tongue carcinoma can go without receiving radiation to the oral cavity without increasing their risk of recurrence, according to a retrospective study presented here at the 2nd World Congress of the International Academy of Oral Oncology (IAOO).

Deepak Kademani, MD, Department of Oral and Maxillofacial Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, presented the findings at an oral abstracts session on July 9.

The researchers reviewed 97 cases where surgery was performed for T1 and T2 node-negative oral tongue squamous cell carcinoma between 1995 and 2005.

Cases that included adjuvant radiation to the oral cavity or positive final surgical margins were excluded from the review, noted Dr. Kademani.

"The amount of toxicity that is associated with radiotherapy affects the oral cavity in terms of increased risk of osteoradionecrosis, change in taste, and other adverse effects," said Dr. Kademani in an interview. "We wanted to see if we could lay the foundation to exclude the oral cavity from irradiation and just treat the neck."

Investigators looked at the relationship between outcome and other variables such as age, tumour size, tumour grade, histologic depth of invasion, intrinsic tongue muscle invasion, initial surgical margin, and treatment of the neck lymphatics.

They found overall survival was 89% at 2 years and 78% at 5 years. Local control was 90% at 2 years and 82% at 5 years.

They also observed that older age at surgery and observation of the neck was associated with a statistically significant decreased survival (P < .01).

At 2 years, overall survival for patients who received neck dissection was 94% and 83% for those who were observed. At 5 years, overall survival was 84% for patients who underwent dissection and 71% for those who were observed.

No tumour characteristics or patient characteristics that were assessed were associated with local control.

Recurrence should not be a challenge if it is detected in the early stages, said Dr. Kademani.

"If we embark on a clinical trial, we would exclude the oral cavity from radiation and just radiate the neck, that should decrease the amount of morbidity associated with radiation to the oral cavity which is a significant problem for patients," said Dr. Kademani.

The complications and toxicity associated with radiation to the oral cavity are typically permanent in patients, he added.

[Presentation title: Clinical Outcomes for T1-2 NO Oral Tongue Carcinoma Treated With Surgery Without Adjuvant Radiation Therapy. Abstract 059]

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