The results of combined treatment surgery and postoperative radiotherapy for tongue cancer and prognostic factors

Yıl 2007, Cilt: 17 Sayı: 1, 1 - 6, 12.01.2007

Ahmet Karadeniz Mert Saynak Züleyha Kadehci Merdan Fayda Görkem Aksu Hümeyra Kocaelli Günter Hafız

Öz

Objectives: We evaluated the results of surgical treatment and postoperative radiotherapy and prognostic factors in patients with primary tongue carcinoma. Patients and Methods: The study included 60 patients 31 males, 29 females; median age 54 years; range 22 to 82 years who underwent surgery and postoperative radiotherapy for oral tongue cancer. Tumor staging based on the AJCC-1997 criteria was as follows: stage I n=1 , stage II n=21 , stage III n=12 , and stage IVA n=26 . Surgery included hemiglossectomy n=46, 76% , partial n=13, 22% and total n=1, 2% glossectomy. Neck dissection was performed in 47 patients 78% . Radiotherapy dose was generally 6000 cGy/30 fr. The median follow-up was 51 months range 5 to 180 months . Results: The five-year overall and relapse-free survival rates were 50% and 47%, respectively. Survival at five years was 70% for stage I-III, and 20% for stage IVA. Most of the relapses occurred in the first two years after treatment. Recurrences were encountered in 31 patients 52% . The median survival after recurrence was eight months range 1 to 53 months . In multivariate analyses, significant prognostic factors for overall survival and locoregional control were tumor size, stage, N stage, extracapsular lymph node spread, and total duration of radiotherapy. Complications were within acceptable limits. Conclusion: Postoperative radiotherapy should be standard for patients with stage III and IVA tongue cancer.

Anahtar Kelimeler

Squamous cell carcinoma, prognosis, radiotherapy, tongue neoplasms

Dil kanserinde kombine tedavi cerrahi ve radyoterapi sonuçlar› ve prognostik faktörler

Öz

Amaç: Cerrahi ve cerrahi sonrası radyoterapi uygulanan primer dil kanserli hastalarda tedavi sonuçları değerlendirildi ve prognostik faktörler araştırıldı.Hastalar ve Yöntemler: Çalışmaya ameliyat sonrasında radyoterapi uygulanan dil kanserli 60 hasta alındı.Hastaların tümör evresine AJCC-1997 göre dağılımı, evre I n=1 , evre II n=21 , evre III n=12 , evreIVA n=26 şeklindeydi. Cerrahi tedavide 46 hastaya %76 hemiglossektomi, 13 hastaya %22 parsiyel,bir hastaya %2 total glossektomi, 47 hastada %78 boyun diseksiyonu uygulandı. Işın dozu genellikle6000 cGy/30 fr idi. Medyan takip süresi 51 ay dağılım5-180 ay idi.Bulgular: Tedavi sonrası beş yıllık genel ve hastalıksızsağkalım oranları sırasıyla %50 ve %47 idi. Beş yıllıkgenel sağkalım evre I-III’de %70, evre IVA’da %20 bulundu. Yinelemeler çoğunlukla ilk iki yılda görüldü. Toplam 31hastada %52 yineleme görüldü. Yineleme sonrası medyan sağkalım sekiz ay dağılım 1-53 ay idi. Çokdeğişkenli analizde, tümör çapı, evre, N evresi, kapsüler invazyonvarlığı ve toplam radyoterapi süresi yerel-bölgesel kontrolve genel sağkalım için anlamlı prognostik faktörler olarakbelirlendi. Tedaviye bağlı komplikasyonlar kabul edilebilirsınırlar içinde kaldı.Sonuç: Ameliyat sonrası radyoterapi evre III ve IVA dilkanseri olgularında standart olarak uygulanmalıdır

Anahtar Kelimeler

Skuamöz hücreli karsinom, prognoz, radyoterapi, dil neoplazileri

Kaynakça

• Boyle JO, Strong EW. Oral cavity cancer. In: Shah JP, editor. Cancer of the head and neck. London: BC Decker; 2001. p. 100-26.
• Hsu IC, Phillips TL. Oral cavity cancer. In: Leibel SA, Phillips TL, editors. Textbook of radiation oncology. Philadelphia: W. B. Saunders Company; 1998. p. 457- 76.
• Kunkler I. Mouth, secondary node of neck, tonsil, nasopharynx, paranasal sinuses, ear, salivary glands. In: Bomford CK, Kunkler IH, editors. Textbook of radiotherapy. 6th ed. London: Churchill Livingstone; 2003. p. 345-77.
• Ridgej A, Glisson BS, Horwitz EM, Meyers MO. Head and neck tumors. In: Pazdur R, Coia LR, Hoskins WJ, Wagman LD, editors. Cancer management: a multidis- ciplinary approach, 8th ed. New York: CMP Healthcare Media; 2004. p. 39-86.
• Cooper JS. The oral cavity. In: Cox JD, Kian Ang K, edi- tors. Radiation oncology: rationale, technique, results. 8th ed. St. Louis: Mosby; 2003. p. 219-54.
• Emami B. Oral cavity. In: Perez CA, Brady LW, editors. Principles and practice of radiation oncology. 3th ed. Philadelphia: Lippincott-Raven Publishers; 1997. p. 981-1002.
• Fleming ID, Cooper JS, Henson DE, Hutter RV, Kennedy BJ, Murphy SP, et al. AJCC cancer staging manual. 5th ed. Philadelphia: Lippincott-Raven; 1997.
• Karadeniz AN. Baş-boyun ve tiroid kanserleri. In: To- puz E, Aydıner A, Karadeniz AN, editors. Klinik On- koloji. İstanbul: İstanbul Üniversitesi Onkoloji Enstitü- sü Yayınları; 2000. s.161-200.
• Zelefsky MJ, Harrison LB, Fass DE, Armstrong J, Spiro RH, Shah JP, et al. Postoperative radiotherapy for oral cavity cancers: impact of anatomic subsite on treat- ment outcome. Head Neck 1990;12:470-5.
• Gilbert EH, Goffinet DR, Bagshaw MA. Carcinoma of the oral tongue and floor of mouth: fifteen years’ expe- rience with linear acceleration therapy. Cancer 1975; 35:1517-24.
• Kazem I, van den Broek P. Planned preoperative radi- ation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma. Laryngoscope 1984;94:1355-8.
• Bamberg M, Schulz U, Scherer E. Postoperative split course radiotherapy of squamous cell carcinoma of the oral tongue. Int J Radiat Oncol Biol Phys 1979;5:515-9.
• Yuen AP, Wei WI, Lam LK, Ho WK, Kwong D. Results of surgical salvage of locoregional recurrence of carci- noma of the tongue after radiotherapy failure. Ann Otol Rhinol Laryngol 1997;106:779-82.
• Vermund H, Brennhovd I, Kaalhus O, Poppe E. Incidence and control of occult neck node metastases from squamous cell carcinoma of the anterior two- thirds of the tongue. Int J Radiat Oncol Biol Phys 1984; 10:2025-36.
• Haddadin KJ, Soutar DS, Oliver RJ, Webster MH, Robertson AG, MacDonald DG. Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 1999;21:517-25.
• O-charoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 2003;39:386-90.
• Fukano H, Matsuura H, Hasegawa Y, Nakamura S. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997;19:205-10.
• Fakih AR, Rao RS, Borges AM, Patel AR. Elective ver- sus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989;158:309-13.
• Schwartz GJ, Mehta RH, Wenig BL, Shaligram C, Portugal LG. Salvage treatment for recurrent squa- mous cell carcinoma of the oral cavity. Head Neck 2000;22:34-41.
• Al-Rajhi N, Khafaga Y, El-Husseiny J, Saleem M, Mourad W, Al-Otieschan A, et al. Early stage carcino- ma of oral tongue: prognostic factors for local control and survival. Oral Oncol 2000;36:508-14.
• Sessions DG, Spector GJ, Lenox J, Haughey B, Chao C, Marks J. Analysis of treatment results for oral tongue cancer. Laryngoscope 2002;112:616-25.
• Matsuura K, Hirokawa Y, Fujita M, Akagi Y, Ito K. Treatment results of stage I and II oral tongue cancer with interstitial brachytherapy: maximum tumor thickness is prognostic of nodal metastasis. Int J Radiat Oncol Biol Phys 1998;40:535-9.
• Varela-Centelles PI, Seoane J, Vazquez Fernandez E, De La Cruz A, Garcia Asenjo JA. Survival to oral can- cer. A study of clinical risk markers with independent prognostic value. Bull Group Int Rech Sci Stomatol Odontol 2002;44:46-51.
• Tankere F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope 2000;110:2061-5.
• Hosokawa Y, Shirato H, Nishioka T, Tsuchiya K, Chang TC, Kagei K, et al. Effect of treatment time on outcome of radiotherapy for oral tongue carcinoma. Int J Radiat Oncol Biol Phys 2003;57:71-8.
• Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR. T2 oral tongue carcinoma treated with radiotherapy: analysis of local control and complica- tions. Radiother Oncol 1989;16:275-81.
• Langendijk JA, de Jong MA, Leemans CR, de Bree R, Smeele LE, Doornaert P, et al. Postoperative radiother- apy in squamous cell carcinoma of the oral cavity: the importance of the overall treatment time. Int J Radiat Oncol Biol Phys 2003;57:693-700.