Floor of mouth cancer: patient selection and treatment results.

Retrospective review of 126 primarily treated floor of mouth (FOM) cancers was done to study patient selection and to search for more optimum treatment strategies. Small surface lesions were treated by local excision (LE); small lesions invading FOM without lymph nodes were treated by radiation alone (RA), while larger lesions and those with palpable nodes were treated by preoperative irradiation and surgery (R + S). Ultimate control of the FOM cancer and nodes was achieved for 100% of the LE, 71% of the RA, and 75% of the R + S patients. The majority of primary tumor and nodal recurrences developed by 15 months and 35% of the failures were salvaged by additional treatment. Change in treatment strategies are suggested for surface lesions because of a poor rate of initial tumor control (43%), for patients treated by RA because of a high rate of complications (41%), and for patients without palpable lymph nodes who can be successfully treated by elective neck irradiation.