Management of the n0 neck in early stage squamous cell carcinoma of the oral tongue.

Balaji, V L (2011) Management of the n0 neck in early stage squamous cell carcinoma of the oral tongue. Masters thesis, Cancer Institute (WIA), Chennai.


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BACKGROUND : Squamous cell carcinoma of the oral cavity accounts for about 30% of all cancers in India1. It is the second most common cancer in India2. This high incidence is attributed to the widespread usage of tobacco, especially oral tobacco. There is a geographical variation among the distribution, with oral cavity cancers being more common in certain parts of India3. The treatment requires a multimodal approach involving surgery and radiotherapy. Currently chemotherapy also is becoming an integral component of the treatment regimes. The single most important prognostic factor in oral cavity carcinoma is the presence of cervical lymph nodes. The occurrence of neck nodal metastases reduces the survival by 50 % and the presence of extracapsular involvement reduces survival by another 50 %4. Contemporary management incorporating advanced radiation techniques, better reconstructive facilities and modern chemotherapy and targeted therapeutic drugs have resulted in better locoregional control. As the main cause of treatment failure is locoregional, the better control rates achieved by the advances in treatment is likely to translate to better survival. AIMS AND OBJECTIVES : To study the incidence and patterns of cervical nodal metastases in patients clinically presenting with T1 / T2, N0 squamous cell carcinoma of oral tongue. 2. To study the various risk factors which predict the development of cervical nodal metastases. 3. To compare the survival outcomes of observation and elective neck treatment. MATERIALS AND METHODS : A retrospective study of patients who presented with malignancies of the oral tongue treated in Cancer Institute (W.I.A) from 1995 to 2005 was done. There were 332 patients who presented with cT1/T2 N0 tongue cancers amongst 890 patients who were treated for oral tongue cancers. Inclusion Criteria : • All patients with biopsy proven squamous cell carcinoma and who underwent their treatment in Cancer Institute. • Clinical T1 / T2 lesions with no palpable neck nodes Exclusion Criteria : • Patients with other histologies • Patients who had undergone treatment elsewhere and presented with recurrent T1 / T2 lesions Pretreatment evaluation consisted of a thorough history and clinical evaluation of the primary site & regional lymph nodes, a biopsy confirmation of histology and Chest Xray for metastatic evaluation. CONCLUSIONS : The incidence of occult ipsilateral neck nodal metastases is around 20 % in T1 & T2 tongue carcinomas • The rates of ipsilateral neck nodal recurrences are much higher (45 %) in patients whose necks are observed. • The incidence of contralateral neck metastases is in the order of 5 % across all treatment groups. • Higher T stage and an infiltrating pattern of growth of the primary were the only significant predictive factors of higher incidence of neck metastases among the factors analyzed. • There was no survival advantage for the elective neck treatment group compared to the observation group. However patients undergoing elective neck dissection had a significantly better disease free and overall survival advantage compared to the observation group. • Neck salvagability rate for the observation group was 76.5% in our series, though 16.5 % of all potentially salvageable patients refused treatment. • Elective neck dissection is to be considered for treatment of all N0 necks in early tongue carcinomas. • Better models predicting occult metastases are required to identify patients with higher incidence of neck node metastases and further randomized prospective studies comparing the treatment options are also the need of the hour.

Item Type: Thesis (Masters)
Uncontrolled Keywords: n0 neck ; early stage ; squamous cell carcinoma ; Management ; oral tongue.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:47
Last Modified: 26 Jul 2017 02:47

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