Management of cervical metastases in advanced squamous cell carcinoma of the base of tongue.

OBJECTIVE

To clarify the role of neck dissection following primary radiotherapy for treatment of squamous cell carcinoma of the base of tongue.

DESIGN

Case series.

SETTING

Academic, tertiary care medical center.

PATIENTS OR OTHER

PARTICIPANTS

A consecutive series of 45 patients with biopsy-proven squamous cell carcinoma of the base of tongue and cervical metastases treated with primary radiotherapy at The University of California, San Francisco, was examined. Patients with a prior history of neck irradiation, neck dissection, or head and neck cancer within 5 years were excluded.

MAIN OUTCOME MEASURES: Overall survival and regional control.

RESULTS

Of the 45 patients treated with definitive radiotherapy, 25 (56%) achieved a complete response, 13 (29%) achieved a partial response, 4 (9%) were nonresponders, and 3 (7%) did not complete radiotherapy. Two thirds of the complete responders had N2 or N3 disease; 3 had recurrences in the neck, 1 of which was an isolated neck recurrence. Of the 13 partial responders, 5 had isolated persistence of disease, with 4 undergoing neck dissections. The only long-term survivors among the partial responders were those 4 who underwent a neck dissection. Overall survival was 50% at 3 years and 32% at 5 years. Regional control for complete responders was 84% at 5 years.

CONCLUSIONS

The low rate of isolated regional recurrence in patients with a complete response to radiotherapy supports the practice of surveillance alone in such patients. Patients with less than a complete response appear to benefit from prompt surgical salvage.